The Graying of America’s Prisons

The following appears as Part One of a two-part Special Report on The Crime Report (TCR), which is “a collaborative effort by two national organizations that focus on encouraging quality criminal justice reporting:  The  Center on Media, Crime and Justice, the nation’s leading practice-oriented think tank on crime and justice reporting, and Criminal Justice Journalists, the nation’s only membership organization of crime-beat journalists.” I’ll post Part Two as soon as it appears on TCR.

Frank Soffen, now 70 years old, has lived more than half his life in prison, and will likely die there.

Sentenced to life for second-degree murder, Soffen has suffered four heart attacks and is confined to a wheelchair.  He has lately been held in the assisted living wing of Massachusetts’ Norfolk prison. Because of his failing health and his exemplary record over his 37 years behind bars—which includes rescuing a guard being threatened by other inmates—Soffen has been held up as a candidate for release on medical and compassionate grounds.

He is physically incapable of committing a violent crime, has already participated in pre-release and furlough programs, and has a supportive family and a place to live with his son. One of the members of the Massachusetts state parole board spoke in favor of his release. But in 2006 the board voted to deny Soffen parole. He will not be eligible for review for another five years.

The “tough on crime” posturing and policymaking that have dominated American politics for more than three decades have left behind a grim legacy. Longer sentences and harsher parole standards have led to overcrowded prisons, overtaxed state budgets, and devastated families and communities. Now, yet another consequence is becoming visible in the nation’s prisons and jails: a huge and ever-growing numbers of geriatric inmates.

Increasingly, the cells and dormitories of the United States are filled with old, often sick men and women. They hobble around the tiers with walkers or roll in wheelchairs. They fill prison infirmaries, assisted living wings, and hospices faster than the state and federal governments can build them—and since many are dying behind bars, they are filling the mortuaries and graveyards as well.

The care these aging prisoners receive, while often grossly inadequate, is nonetheless cripplingly expensive—so much so that some recession-strapped states are for the first time seriously considering releasing older terminally ill and mentally ill prisoners rather than pay the heavy price for their warehousing. It remains to be seen what will happen when such fiscal concerns run head on into America’s taste for punitive justice. A recent report by the Vera Institute made this clear.

Politicians no doubt did not imagine this Dickensian landscape of the elderly incarcerated when they voted to lengthen sentences and impose mandatory minimums three or four decades ago. But their actions are yielding an inevitable outcome.  While the graying of the prison population to some extent reflects the changing demographics of the populace at large, it owes considerably more to changes in law and policy. And this is likely to continue into the foreseeable future.

According to the Sentencing Project, the United States imprisons five times as many people as it did 30 years ago and more than seven times as many as it did 40 years ago. Our criminal justice system now keeps 2.3 million people behind bars—about half of them for drug offenses and other nonviolent crimes. Twenty-five years ago, there were 34,000 prisoners serving life sentences; today the number is more than 140,000. The fact that each person is spending a longer stretch behind bars means that the falling crime rates of the 1990s do not translate into fewer inmates. It also means that more and more people who committed offenses in their 20s or even their teens are growing old and dying in prison.

The situation is particularly stark in California, Texas and Florida, which have large prison populations with cells crammed to overflowing because of harsh sentencing laws. In California, the population of prisoners over 55 doubled in the ten years from 1997 to 2006. About 20 percent of California prisoners are serving life sentences, and over 10 percent are serving life without the possibility of parole. Louisiana’s prison system now holds more than 5,000 people over the age of 50—a three-fold increase in the last 12 years.

While 50 or 55 may not be old by conventional standards, people age faster behind bars than they do on the outside: Studies have shown that prisoners in their 50s are on average physiologically 10 to 15 years older than their chronological age. Older prisoners require substantial medical care, because of harsh life conditions as well as age. Inmates begin to have trouble climbing to upper bunks, walking, standing on line, and handling other parts of the prison routine. They suffer from early losses of hearing and eyesight, have high rates of high blood pressure and diabetes, and are susceptible to falls.

A recent study by Brie Williams and Rita Albraldes, published as a chapter in the book Growing Older: Challenges of Prison and Reentry for the Aging Population, found that in addition to the chronic diseases that increase with age, older offenders have problems such as paraplegia because of the legacy of gunshot wounds. Many have  advanced liver disease, renal disease, or hepatitis. Still others suffer from HIV-AIDS, and many more from drug and alcohol abuse. Living under prison conditions, they are more likely to get pneumonia and flu.

Many prisons are notorious for not taking their inmates’ health complaints seriously, and there is anecdotal evidence this problem may be compounded when prisoners are elderly. A doctor under contract in one southern prison told me in a recent interview how a diabetic man’s illness was misdiagnosed, resulting in months of excruciating pain and the amputation of toes and part of one foot. Back in prison, the man asked for prosthetic shoes so he could get around by walking; his request was denied.

Another elderly prisoner complained of an earache which went untreated for months.  When it became unbearably painful, the prisoner was shipped to a local hospital emergency room, under contract to the prison. There the doctors found the earache was brain cancer—by then, too advanced to treat.

The exploding prison population has further undermined the already questionable quality of inmate medical care. In California, which has the nation’s largest number of state prisoners, a panel of federal judges earlier this year found that the state of medical care was so poor that it violated the Constitution’s ban on cruel and unusual punishment, and was in danger of routinely costing prisoners their lives. The only solution, the judges said, was to reduce prison overcrowding caused by the states draconian mandatory sentences. The court recommended shortening sentences and reforming parole, which they believed would have no impact on public safety; it has given California three years to comply.

To come in Part Two:  Challenging the status quo for geriatric prisoners

War Wounds: VA Ignores an “Epidemic” of Veteran Suicides

This Veterans Day, tributes continue for the 13 soldiers killed last week at Ford Hood, gunned down by one of their own. It was a shocking and terrible event, which warranted the outpouring of sorrow it inspired. Yet every single day, on average, more current and past members of the U.S. armed services die by their own hands than were killed on November 5 at Fort Hood.

According to the Department of Veterans Affairs’ own calculations (which it tried to conceal from a CBS News probe, and from the public), there are “about 18 suicides per day among America’s 25 million veterans.” That’s well over 6,000 a year. In addition, the VA admits that “suicide prevention coordinators are identifying about 1,000 suicide attempts per month among veterans we see in our medical facilities.” Rates are highest among young men in their twenties, veterans of our current wars. And these numbers do not include suicides by active duty members of the military. In 2008, these numbered nearly 250 (Army 128, Navy 41, Marines 41, Air Force 38)–five every week.

There are no public outpourings of grief for these servicemen and women, whose deaths must often have followed prolonged suffering from PTSD, traumatic brain injury, depression, or plain old despair. There are no weeks of nonstop media coverage, no tributes at Veterans Day parades, and no memorial services with eulogies by the president. In fact, it has been a longstanding policy that the families of soldiers who commit suicide do not even recieve a letter of condolence from the president.

At best, there are sporadic news reports noting the high rates of suicide, and the occassional Congressional hearing. And while increasing lip service has been paid to improving mental health care for veterans, in reality, the VA has set up multiple obstacles to such care.  As The Nation reported last year, the VA has delayed or denied disability and medical benefits to thousands of Iraq and Afghanistan veterans because they couldn’t “prove” that their conditions were “service-related.” In addition, “a recent Inspector General report found that 70 percent of VA facilities don’t have a system to track suicidal veterans. Only a handful of VA hospitals have rehab programs that include families. And soldiers injured today face a benefits waiting list more than 650,000 veterans long.” One doctor in the VA’s leadership who publicly criticized these shortcomings was summarily fired.

Even the true statistics on veteran suicides would never have come out were it not for a class action lawsuit by Veterans for Common Sense (VCS) and Veterans United for Truth, who sued the VA in federal court. According to the veterans’ groups:

Many veterans who have fought in Iraq and/or Afghanistan, as well as those who served in earlier conflicts, are not being given the disability compensation, medical services and care they need. A much higher percentage of these veterans suffer with Post Traumatic Stress Disorder (“PTSD”) than veterans of any previous war, due to the multiple tours many are serving, the unrelenting vigilance required by the circumstances, the greater prevalence of brain injuries caused by the types of weaponry in use, among other reasons. Despite this, the Department of Veterans’ Affairs (“DVA”) is failing to provide adequate and timely benefits and medical care.

The judge who heard the case in federal district court in San Francisco–himself an 86-year-old veteran of World War II–said he was sympathetic to the plaintiffs’ cause, but he found against them. According to VCS, “In his decision, Judge Conti held that although it is clear to the Court that the VA may need ‘a complete overhaul’ the the power to remedy this crisis lies with the other branches of government.” In other words, if the VA can’t or won’t fix itself, it’s time for Congress and the White House to step up and do something about this travesty.

Dog Days Turn Deadly in America’s Prisons

ADC photo of Marcia Powell

The summer of 2009 had barely begun when Marcia Powell, a 48-year old inmate at Arizona’s Perryville Prison, was baked to death. Powell, whom court records show had a history of schizophrenia, substance abuse, and mild mental retardation, was serving a 27-month sentence for prostitution. At about 11 a.m. on May 19, a day when the Arizona sun had driven the temperature to 108 degrees, she was parked outdoors in an unroofed, wire-fenced holding cell while awaiting transfer to another part of the prison. A deputy warden and two guards had been stationed in a control center 20 yards away, but nearly four hours had passed when she was found collapsed on the floor of the human cage. Doctors at a local hospital pronounced Powell comatose from heat stroke, and she died later that night after being taken off life support. Two local churches stepped in to provide a proper funeral and burial.

Arizona Department of Corrections director Charles Ryan said the guards had been suspended pending a criminal investigation. But just yesterday, the Maricopa County Medical Examiner ruled the death an accident, caused by “complications of hyperthermia due to environmental heat exposure.” This despite the fact that Powell had blistering and first and second degree “thermal injuries” on face, arms, and upper body.

Ryan also expressed “condolences to Ms. Powell’s family and loved ones”–a strange statement, considering Ryan had made the decision to quickly pull the plug on his comatose prisoner because, he said, no next of kin could be found. In fact, as Stephen Lemons of the Phoenix New Times has reported, Powell was judged an “incapacitated adult” and placed under public guardianship–but her guardians were not consulted before the ADC elected to let her die. Lemons also noted some unsavory chapters in Ryan’s recent career:

Ryan’s own bio on the ADC Web site touts that he was “assistant program manager for the Department of Justice overseeing the Iraqi Prison System for almost four years.” Ryan was contracted by the DOJ to help rebuild Iraqi prisons, one of those being the notorious Abu Ghraib.

Following Powell’s death, Ryan banned most uses of unshaded outdoor holding cells in Arizona, except in “extraordinary circumstances.” Most Southern states already restrict their use. But baking in the sun is only one of many ways to die in America’s prisons in the summertime. Recent years have seen scattered reports of heat-related prison deaths in California and Texas, among others. The prevalence of mental illness among the victims may be linked to anti-psychotic drugs, which raise the body temperature and cause dehydration, and at the same time have a tranquilizing effect that may mask thirst.

In 2006, 21-year-old Timothy Souders, another mentally ill prisoner, died of heat exhaustion and dehydration at a Jackson, Michigan prison during an August heat wave. For the four days prior to his death, Souders had been shackled to a cement slab in solitary confinement because he had been acting up. That entire period was captured on surveillance videotapes, which according to news reports clearly showed his mental and physical deterioration.

The vast majority of U.S. civilian prisons and jails are not air conditioned. (In contrast, the U.S. made a point of building new air-conditioned facilities for prisoners at Guantanamo Bay, and phasing out the older structures.) In Texas, only 19 of 112 prisons have air-conditioning. Earlier this summer, the chair of Texas State Senate’s Judiciary Committee, John Whitmire (D-Houston), told the Houston Chronicle that enduring the heat is “part of the reality of going to prison. There are a lot of inconveniences to serving time. There’s no question it’s hot.” He said he thought few Texans would be sympathetic to the prisoners’ suffering.

Apparently anticipating a similar lack of sympathy, the Florida Department of Corrections proudly advertises the absence of air-conditioning in most of its prisons. On a web page that debunks a host of “misconceptions” that might indicate soft treatment of Florida’s prisoners, it assures readers that the majority of inmates live without air-conditioning or cable television.

In a 2002 report on the risks of heat-related illness at the Mississippi State Penitentiary in Parchman, compiled for the ACLU, a physician who reviewed conditions on Death Row wrote the following:

An individual free to respond to the stress created by a hot environment would normally take steps to cool his body. If no air conditioning were available, he would at least respond by seeking a cooler location, blocking out radiant heat from the sun by positioning himself in the shade or screening himself from the sun, maximizing evaporation by wetting his body and clothes with water and using fans to create cross-ventilation, and moving away from physical structures which absorb and radiate heat.

None of these natural survival responses to excessive heat are available to the Death Row prisoners. The prisoners’ cells, especially Willie Russell’s Plexiglas covered cell, are stifling hot yet prisoners have to close their windows and cover their bodies at night despite intense heat in order to protect themselves from mosquitoes and other insects. Many of the prisoners have no access to fans, either because they are too poor to buy fans or because their fans have been confiscated as punishment. They have infrequent access to cooling showers, and sometimes, even access to water is extremely limited. The prisoners are not allowed to shade their windows from direct sunlight. They have extremely limited access to the outdoor exercise-pens and in any event those pens provide no relief from the heat because they are not shaded….

It is my opinion, based on my observations during my visit to Unit 32-C, Death Row and on my training, experience, and familiarity with the extensive body of medical literature on the subject of thermoregulation, that all of the inmates on Death Row are at high risk of heat stroke and heat-related illness.

A first-hand account of enduring the summer heat at the nation’s largest maximum-security prison, the Louisiana State Penitentiary at Angola, was provided by Kenny “Zulu” Whitmore. Whitmore, who has served more than 30 years of a life sentence, much of it in solitary confinement, kept a journal during a 2007 August heat wave:

August: It was so hot in here last night…I looked for the open flame in the cell. During the day you expect it to be 100 degrees, but not at night. More is yet to come.

9 August: The fire inspector came on the tier today doing the same fake B/S, but he was soaking wet b/c it is so hot in here. He was RED RED in the face like he was going to pass out. He was looking at us like Lord, give me their endurance.

12 August: I could not sleep last night. It had to be at least 98 degrees in here. I passed out around 2.20 am and got up at 5.14…I have not stopped sweating since yesterday….

31 August: The last day of hell month. This had to be the hottest for August in 200 years.

More recently, in letters to a friend, Whitmore described this past summer at “the Gola”:

June 11, 2009: Heat is on in the Gola, 93 degrees. I would have replied yesterday, but man it was so hot in here and I sweated all day. So I am writing before it gets too hot. And it’s just June. It was 76 degrees that morning at 5.30 am and 94 degrees after twelve noon. It should get that hot today too….

 June 27, 2009: Hot n Humid Gola 99 degrees. If you heard that it’s getting hot in Angola, you heard wrong, because it have been steaming hot in Angola for the whole month of June but I know H will be alright, even at his age he can stand the heat. Plus: he knows what to do to cool down some: put some water on the floor and lay in it or put a wet sweat shirt on to stay cool….

 July 12, 2009: The sweatbox Louisiana. With temperature 98 degrees everybody is on the floor. All you need is to wet it or your clothes. It’s all about survival in this man made hell….

 August 10, 2009: I ran like a wild horse in that 96 degree heat today. I sweated all my body liquids so I had to replace it by drinking water the whole of the day. Only the strong survive.

Ghostwriters Pushed Paxil

The unfolding story of how the big drug makers use ghostwriters to compose articles for insertion in medical journals–signed by hired doctors who have nothing to do with the writing–just gets worse and worse. Now we have the case of the anti-depressant Paxil.

I have some personal experience on this front. Several years ago, I went to a psychiatrist–or rather, one of the pill-prescribers who are now known as psychopharmacologists. His diagnosis technique consisted of giving me a list of 10 questions:  Do you wake up in the morning feeling blue? Do you feel tired a lot of the time? Have trouble sleeping? Ever think about suicide? Tallying up the answers, he grinned at me and said, “You’ve got seven out of ten.” Then he reached into a cabinet, rummaged around, and came out with a few trial packages of Paxil. “Here,” he said, tossing them to me, “try this.” After a couple of years on Paxil, after experiencing a big weight gain and feeling blotto half the time, I tried to get off and immediately was plunged into a nightmare withdrawal.

My reaction was apparently mild compared to what others have gone through. Paxil is now notorious for its withdrawal symptoms, and GlaxoSmithKline was sued for suppressing the results of its own study showing that Paxil increased the suicide risk in children. So what convinced this doc to prescribe Paxil as his first course of treatment? Here lies at least part of the answer. The Associated Press reports on how GlaxoSmithKline P.L.C., the big drug maker, employed ghostwriters to promote the Paxil.

An internal company memo instructs salespeople to approach physicians and offer to help them write and publish articles about their positive experiences prescribing the drug….

The document was uncovered by the Baum Hedlund  law firm of Los Angeles, which is representing hundreds of former Paxil users in personal-injury and wrongful-death suits against Glaxo. The firm alleges the company downplayed several risks connected with its drug, including increased suicidal behavior and birth defects.

A spokeswoman for London-based Glaxo said the published articles noted any assistance to the main authors.”The program was not heavily used and was discontinued a number of years ago,” said Mary Anne Rhyne.

According to the memo, which dates from April 2000, the program was designed to “strengthen the product positioning and overcome competitive issues.”

At the time, Paxil was competing with antidepressant blockbusters from Eli Lilly & Co. (Prozac) and Pfizer Inc. (Zoloft). Paxil has since lost its patent protection and competes against cheaper generic versions. Sales of Paxil last year totaled $849 million.

Prisons Becoming Warehouses for the Old

AGING BEHIND BARS SERIES

I have written hefore about the aging population in American prisons and jails, due in large part to the draconian sentencing policies of the courts, federal, state, and local. As a result these places seem destined to become nursing homes surrounded by razor wire.  

Angola prison in Louisiana, for instance, boasts that some 90 percent of its population will die there. The prison has managed to equip itself with a hospice, and trained inmates to attend to a convict’s last days. Burl Cain, the warden, is backed up by a phalanx of Christian fundamentalist preachers who freely roam the 18,000 acre former slave plantation recruiting inmates to be preachers. The clergy instruct  prisoners their only way out is through redemption made possible by the  acceptance of Jesus Christ. When an elderly inmate, knowing his end was near, sought to be win release so as to die in the so-called “free world,” the parole board refused. The procedure is to go to your death in the Christian way–from cell to hospice to a prison cemetery where your grave will be dug by the inmates who will mark your bruial with gospel hymns

 The travesty at Angola is held up as a model  for the nation and Cain celebrated by the media  as a new corrections messiah. Elsewhere,old,sick people,piled into these living tombs by the courts, stand in line for hours to get an aspirin; arthritic old women  are made to climb into upper bunk beds.Parapalegic men are denied canes, which are ruled to be weapons, and instead must crawl to the toilets.People are locked in solitary for years. Mentally ill convicts who act out in the general population are put into solitary because they howl and scream in public.  Locked down, they go truly mad. Old sex offenders can be released into the hands of friends or family. but often noone wants them, so they are released to the county jail, reindicted, and sent back to prison.

The American public is  up in arms about  CIA jails in far away places. But it  could care less about American prisons. Now a new report by the Sentencing Project in Washington adds to the growing body of information about  prisons here at home. No Exit: The Expanding Use of Life Sentences in America contains, among other things, the first nationwide collection of life sentence data documenting race, ethnicity and gender, and reveals “overwhelming racial and ethnic disparities in the allocation of life sentences”: 66% of all persons sentenced to life are non-white, and 77% of juveniles serving  life sentences are non-white.

  The the report’s key findings:

140,610 individuals are serving life sentences, representing one of every 11 people (9.5%) in prison. Twenty-nine percent (41,095) of the individuals serving life sentences have no possibility of parole.

The number of individuals serving life without parole sentences increased by22% from 33,633 to 41,095 between 2003 and 2008. This is nearly four times the rate of growth of the parole-eligible life sentenced population.

In five states—Alabama, California, Massachusetts, Nevada, and New York—at least 1 in 6 people in prison are serving a life sentence.

The highest proportion of life sentences relative to the prison population is in California, where 20% of the prison population is serving a life sentence, up from 18.1% in 2003. Among these 34,164 life sentences, 10.8% are life without parole.

Racial and ethnic minorities serve a disproportionate share of life sentences. Two-thirds of people with life sentences (66.4%) are nonwhite, reaching as high as 83.7% of the life sentenced population in the state of New York.

 There are 6,807 juveniles serving life sentences; 1,755, or 25.8%, of whom are serving sentences of life without parole.

Seventy-seven percent of juveniles sentenced to life are youth of color.

There are 4,694 women and girls serving life sentences, 28.4% of females sentenced to life do not have the possibility of parole.

Big Pharma Profits from Grandmother’s Little Helpers

The Kaiser Daily Health Policy Report today summarizes two new studies from the journal Health Affairs, documenting the explosion in the use–and cost–of psychotropic drugs over the last decade. One study found that between 1996 and 2006, “prescriptions for mental health medications increased by 73% among U.S. adults and by 50% among children.”  As of 2006, one in 10 U.S. adults takes at least one prescription for this purpose.

I’ve written before about the growth of antidepressant use among the over-65 crowd (myself included), which seems to be the new way to deal with what a drag it is getting old. But the new study also finds dramatic growth in the use of other medications: “The study found that the number of U.S. seniors receiving psychotropic medications, including dementia and antipsychotic drugs, doubled during that time period.”

This points, in particular, to the increasing treatment of older people with cognitive loss, and any kind of agitated or unruly behavior, as “psychotic.” It’s impossible to know for sure, but I suspect this has something to do with the fact that the drug companies have been pushing their lucrative psychiatric medications on this vulnerable population–the most notorious (and illegal) example being Lilly’s campaign to urge doctors to prescribe the antipsychotic drug Zyprexa for off-label use on elderly patients with dementia.

Unsurprisingly, the second study published in Health Affairs documents a steep rise in spending for mental health care during the same ten-year period–more than 30%, with “nearly all of the increase caused by psychiatric drug costs.” Big Pharma reaps even more rewards from mental health than from other medical fields: “Drugs accounted for 51% of mental health care costs in 2006, while drugs accounted for 26% of spending for all other health care costs, according to national data.” The Kaiser article makes note of the trend toward “greater reliance of the use of psychiatric drugs compared with other forms of psychosocial treatments such as therapist visits.”

This is especially bad news for old timers, since the weakest link in their health coverage isn’t psychotherapy–which Medicare covers pretty generously–but prescription drugs. This is due to the inadequate Medicare Part D program, which was designed to benefit drug and insurance companies at the expense of beneficiaries (and taxpayers). And it turns out that elders with mental health issues get particularly screwed by Part D: A recent study found that on average, we will fall into the infamous “donut hole”–the gap where all coverage for prescriptions ceases–two months earlier than others.

Several reports issued since the recession began have shown that older people simply stop filling some of their prescriptions when they can’t afford them. So what’s going to happen when all us geezers who have come to depend on Big Pharma’s little helpers stop taking our meds?

Aging Behind Bars

Among the grotesque realities of modern American life is the exponential rise of geriatric prisoners–men and women in their 60s, 70s, 80s, and even 90s, who committed crimes decades ago, are feeble and ill, yet remain incarcerated not only as a punitive measure, but on the premise that are a threat to society. Many of these people want to get out of prison only so they can die in what many call the “free world.”

People age faster behind bars faster than they do on the outside: Studies have shown that prisoners in their 50s are on average physiologically 10 to 15 years older than their chronological age, so 55 is old in prison. And even by conventional standards, the United States is experiencing an exponential jump in the number of old people in prison. The causes of this increase go beyond the graying of the population at large: Long mandatory sentences without parole mean that offenders who enter prison while still in their teens or twenties may remain there until they are old–if they don’t die first.

The problem is most acute in states like California, Texas, and Florida, which have large prison systems and strict and harsh sentencing laws. In California, the population of prisoners over 55 doubled in the ten years from 1997 to 2006. This contributes to the overcrowding that has reached crisis proportions. It also yields a sense of utter hopelessness within prison walls. At the Louisiana State Penitentiary in Angola, some 85 to 90 percent of the men who pass through the prison gates will never leave. Angola has its own hospice, mortuary, and graveyard.

Older offenders are of course more likely to suffer from serious medical conditions, and unlikely to receive the care they require. Old people in any institutional setting may find that their health complaints are not taken seriously, due to some combination of dismissive attitudes and cost-cutting. In prison, such factors apply in the extreme. When I spoke with health care providers working in one Southern prison, they described a diabetic man’s illness was misdiagnosed by the prison, resulting in months of excruciating pain and the amputation of toes and part of one foot. Back in prison, the man asked for prosthetic shoes so he could get around by walking; his request was denied. Another man complained of an earache for months. He was given drops, but the pain persisted. Eventually he was sent to a local hospital emergency room, where doctors discovered the earache was in fact brain cancer, which might have been treated if discovered back when he first complained. Now he is terminal.

Brie Williams of the University of California Medical School at San Francisco and Rita Albraldes, an independent researcher, recently completed a study that was published as a chapter in the book Growing Older: Challenges of Prison and Reentry for the Aging Population. They found that the cost for each geriatric inmate came to $70,000 a year. In addition to the chronic diseases that increase with age, these offenders have have problems such as paraplegia because of gunshot wounds, and advanced liver disease, renal disease, hepatitis and HIV from drug and alcohol abuse. Living under prison conditions, they are more likely to get pneumonia and flu.

Many older offenders suffer from serious mental illness–some of it lifelong, and some of it produced by their incarceration. One study revealed depression among male prisoners was 50 percent higher than for those living outside. All in all, 54 percent of older prisoners met standards for psychiatric disorders. Williams and Abraldes write, “In one report from a maximum-security hospital, 75 percent of elderly prisoners were admitted between age 20 and 30 and the majority were schizophrenic.” At Angola, the warden reported that 2,000 of over 5,000 inmates were on psychotropic drugs. Many mentally ill prisoners are simply warehoused and fed drugs to keep them under control. Even worse, some are labeled “discipline” problems, and end up in solitary confinement.

Jonathan Turley, a George Washington University law professor and founder of the Project for Older Prisoners, has written extensively about alternatives for aging offenders: for lower risk prisoners, various forms of supervised release, including electronic bracelet monitoring; and for higher risk prisoners, geriatric units, where the cost of better care could be more than balanced by reducing the number of corrections officers. “Although a geriatric prisoner may still be a risk for a given category of crime,” Turley writes, “he is unlikely to toss his walker over a razor-wire fence or outrun perimeter guards.”

In 2008, the federal government finally launced the Elderly Offender Home Detention Pilot Program, under which old prisoners can be released into a kind of supervised house arrest. As outlined by Families Against Mandatory Mimimums, eligibility guidelines are strict: Offenders must be over 65, and must have served at least 10 years and 75 percent of their sentences; no lifers and no perpetrators of “crimes of violence,” including sex crimes and firearms violations. Total number expected to participate: 80 to 100 nationwide, out of a total federal prison population of over 200,000. In Pennsylvania, after lengthy study conducted by a special Advisory Committee on Geriatric and Seriously Ill Inmates, the state also launched a pilot project. Total prisoners released in one year: eight to ten.