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Texas Pays for Geriatric Prisoners, Rarely Grants Medical Parole

by Matt Clarke

In the Texas Department of Criminal Justice (TDCJ), geriatric prisoners – those over 55 years old – comprise only 7.3% of TDCJ’s population. However, they account for almost one-third of the prison system’s medical expenses. Geriatric prisoners average $4,700 in annual health care costs compared to an average of $765 for prisoners under age 55.

Further, the medical care system for TDCJ prisoners is nearly bankrupt despite an annual budget of close to a half-billion dollars. Recently, the University of Texas Medical Branch (UTMB), which provides health care to Texas state prisoners, had to lay off 363 employees due to an unexpected budget shortfall. UTMB announced in November 2010 that it wants to stop providing medical care for most TDCJ prisoners when its current contract expires in August 2011.

With TDCJ’s health care system near collapse and geriatric prisoners making up a large percentage of medical costs, it would make sense to parole those prisoners whose age or illnesses render them too infirm to be a danger to the public. That was the idea behind medical parole in Texas, known formally as “medically recommended intensive supervision.” Yet of the 4,000 prisoners recommended for medical parole by UTMB doctors over the past decade, only about 1,000 – or 25% – have been approved by the Texas Board of Pardons and Paroles.

“You can be sick, have an illness or a disease, and still be a threat,” stated Rissie L. Owens, who chairs the parole board. “Our decisions aren’t based on numbers, on quotas. And we feel like we’re making good decisions.”

But not all state officials agree with that assessment.

“These are totally incapacitated inmates, terminally ill inmates, inmates on respirators, who are not paroled at a huge expense to the state and hardship to the inmate’s family because of the nature of a crime they may have committed 20 or 30 years ago,” said state Senator John Whitmire, who chairs the Senate Criminal Justice Committee. “I think it’s largely for political reasons.”

Although Texas has stabilized its prison population, the number of geriatric prisoners is increasing at a rate of 6% per year. At the same time the average medical cost for state prisoners is growing at 4% annually. This worries budget analysts who have to predict future TDCJ costs.

The most expensive prisoners run up medical bills of close to $1 million a year. If they were in outside hospice or nursing homes, the federal government would pick up two-thirds of that tab under Medicaid – saving the state an estimated $50 million annually. If medically-paroled prisoners qualify for Medicare, the feds would pay 100% of the costs.

“We could be transitioning them to some other facility where state taxpayers wouldn’t have to bear the full health care costs,” stated Marc Levine, director of the Texas Public Policy Foundation’s Center for Effective Justice. Levine suggested separate hospice or nursing homes monitored by parole officers as a way to save money without increasing the risk to public safety.

The national one-year recidivism rate for prisoners over age 55 is 3.2%. For prisoners between 18 and 29 years old, the rate is 45%. That alone speaks favorably for paroling geriatric prisoners, especially those who are infirm. Nonetheless, an April 2010 report by the VERA Institute of Justice, titled “Aging Prisoners, Increasing Costs, and Geriatric Release,” found that the 15 states with medical release policies rarely use them. The report concluded that politics, complicated review processes and limited eligibility prevent effective use of medical release policies. [See, e.g.: PLN, Oct. 2010, p.30].

The Texas parole board won’t generally grant medical parole to a prisoner for a condition the prisoner already had when the crime was committed. Even when granted, processing medical paroles is slow. In FY 2009, 31 Texas prisoners died while awaiting an answer to their medical parole requests. Twelve were approved for medical parole but died before they could be released. Twenty-six died after they were rejected for medical parole.

“There are documented cases where individuals had days or weeks left to live” but were rejected for medical parole, according to Senator Whitmire. “I saw no reason why they shouldn’t be paroled so the family could make plans for their funeral.”

This is an issue in other states as well. The number of geriatric prisoners in state and federal prisons grew 75% between 1999 and 2007. Over a dozen states have opened units for geriatric prisoners, and eight now have prison hospice units.

While paroling elderly and infirm prisoners seems a no-brainer when it comes to saving taxpayer money without compromising public safety, politics and the retributive nature of our justice system have made it the exception rather than the rule.

Sources: Texas Tribune,,

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