Medical parole legislation could save money

Larry, 70, has Alzheimer's disease and suffers from heart disease. He's also a convicted felon serving 15 to 30 years in the state prison for intimidation and assault.

"He cannot bathe himself. He cannot dress himself. He's totally disoriented. He has problems with balance," said Joyce Leeka, a manager at the prison infirmary.

Larry is one of a growing number of older inmates whose medical problems strain the system and help make prisons one of the fastest growing parts of the state budget.

State Rep. Larry Elliott wants New Hampshire to join roughly 13 states, including Connecticut and Rhode Island, in authorizing medical parole for inmates incapacitated by medical problems or chronic illnesses.

Moving the most medically needy inmates to facilities outside the prison would save the state at least 50 percent of the cost of their care. That's due in part to rules for Medicaid and Medicare, federal health coverage for the poor and elderly. Prison inmates are not covered by those programs, so the state pays the full cost.

Outside the prison walls, the same individuals are covered. For inmates with private insurance, the savings would be 100 percent.

"I'm tough on crime and I think people should serve, but in this instance there's a crime against taxpayers," said Elliott, R-Hillsborough. "The prison is not set up as a nursing home."

Larry, who is not competent to consent to having his full name used, was incarcerated several years ago, before he developed Alzheimer's. He lives in the prison infirmary. He needs round-the-clock care because he often awakens at night.

"He gets very confused and as a result gets very upset," Leeka said. He needs his own room not only because he disturbs other inmates but because he is likely to be taken advantage of by them.

Keeping Larry in prison costs $166,000 a year, nearly seven times the $25,000 cost for a healthy inmate, corrections officials say.

Treating an inmate with cancer can cost $75,000 per year, said Robert McLeod, chief of medical and forensic services for the state prison. Caring for a paraplegic inmate runs upward of $100,000 per year.

"About 50 percent of our total budget goes to chronic care as opposed to acute care," McLeod said.

Roughly 13 percent of inmates in the prison system are 50 or older, a figure that's almost doubled in the past 10 years and is expected to continue to grow.

By age 50, inmates are increasingly likely to develop serious health conditions, McLeod said. Few took good care of their health outside the prison and many abused alcohol and drugs. As a result, AIDS, heart disease, lung disease, liver disease and a variety of chronic conditions hit inmates hard at a younger age.

The bill would limit medical parole to inmates with terminal, incapacitating or incurable medical conditions. No inmate sentenced to death or life without parole would be eligible. The Parole Board, of which Elliott is a member, would have to agree the inmate was not a danger to the public or likely to commit new crimes.

"Public safety is the first criterion," Leeka said.

Skeptics worry that inmates might injure themselves or feign illness to win early release. Anticipating those concerns, the bill requires parolees whose health improves to return to prison, and officials could demand periodic checkups.

McLeod said medical parole would be an option for about six inmates at present and perhaps one to three inmates per year in the future.

Larry is about to be released on parole to an Alzheimer's facility, a move Leeka said took two years to arrange and the cooperation of multiple agencies and a judge.

But the Corrections Department was unable to win early parole for a paraplegic inmate who can't use his legs because of a malignant tumor on his spine. A judge denied the request even though the crime victim supported it, Leeka said.

Meanwhile, an inmate in Berlin dying of lung cancer was approved for release to a nursing home.

"What we need is consistency. There needs to be consistency in how we approach looking at people for medical parole," Leeka said.

In 1995, the system spent $1.3 million for health care for 1,988 inmates. Of those, roughly 170 were over 50.

This year, the prison population is up to 2,475 and 320 inmates are over 50. Spending on health care is up to $7.6 million.

"If we don't start doing some of these interventions, that trend is going to continue," McLeod said.