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Report: Medical care accounts for a fifth of operating expenses for state prisons in Va.

RICHMOND — The price of medical care for Virginia’s 30,000 inmates now accounts for one-fifth of all operating expenses for state prisons and is driven in part by an aging inmate population, a new report says.

The cost of inmate health care grew from roughly $140 million per year to more than $230 million in the decade that ended June 30, according to figures in the Update on Inmate Health Care report from the staff of the Virginia House Appropriations Committee.

Fourteen percent of state prisoners are at least 55 years old, up from 8.5% in 2012, the report found. A review last year by the Joint Legislative Audit and Review Commission reported the number of inmates age 50 or older increased by nearly 40% from 2010 to 2016, and there was no indication that the growth rate was slowing.

The House of Delegates’ report noted that Virginia has the second-tightest criteria for releasing elderly inmates in the country and that it is the only state that does not allow for the release of inmates with serious, non-terminal illnesses or those with permanent disabilities.

A 1976 U.S. Supreme Court decision held that under the Eighth Amendment bar against cruel and unusual punishment, inmates have a right to a standard of health care that is available in the community.

To be eligible for conditional release in Virginia under current law, an inmate must be 65 or older and have served five years of their sentence, or be 60 and have served at least 10 years; or have a terminal diagnosis with less than three months to live; and he or she cannot have been convicted of capital murder.

Fewer than 20 Virginia prisoners have been released under those policies in the past five years, the report says. Most other states have established a parole-like process to review inmate applications for conditional release that make the cost of the inmate’s medical needs a factor to be considered, according to the report.

In Virginia, geriatric conditional release is handled by the parole board, and releases for those with less than three months to live — if not also eligible for geriatric conditional release — are ruled on by the governor’s office.

There may be legislation introduced in the upcoming General Assembly to address the growing medical costs, said state Del. Mark D. Sickles, D-Fairfax, who plans to reintroduce a bill that died last year that would have expanded so-called “compassionate” releases.

It would allow for any prisoner — not convicted of capital murder — who is terminally ill or who is permanently physically disabled to be eligible for consideration by the parole board for conditional release. It would also allow the parole board to conditionally release geriatric inmates without the inmates being required to petition the parole board for such a release.

Sickles said there was opposition from prosecutors concerned that too many people would be released and from some other legislators who questioned how it could be determined that a prisoner was terminally ill.

“Doctors do that every day,” he said.

Sickles said that with a number of new prosecutors and because Democrats now control the General Assembly, his bill might be passed in the upcoming session.

“I think we have a better shot now,” he said.

“Our medical bill for our incarcerated population is over $200 million,” said Sickles, adding that his bill would save money and show some compassion to deserving offenders.

“There would be a very small set of patients that are over 60 that have a terminal diagnosis,” he said.

Sickles said many remaining inmates may be “the worst of the worst.” But he said “the system needs to be looked at hard. I believe that Adrianne Bennett [the parole board chair] and her fellow parole board members are doing an excellent job. They’re trying to get uniformity and policies in place.”

Last year’s JLARC report found that only Kansas had a more stringent time requirement than Virginia’s. The Virginia prison system spent an average of $61,000 for 65 inmates who died in the year that ended June 30, 2017.

JLARC reported that those 65 inmates amounted to just 0.2% of the inmate population, but their end-of-life care accounted for 4.7% of the Department of Corrections’ health care spending.

According to JLARC, Virginia spends more on inmates with complex long-term medical conditions — an average of $20,000 for 810 such inmates — than on inmates generally. Those 810 comprised 2% of the inmate population but received 20% of the department’s health care spending.

The report to the House Appropriations Committee said the Department of Corrections uses outside contractors to provide medical care for 15,000 inmates at 14 facilities with high levels of medical need and a history of difficulty recruiting qualified staff.

But the practice carries risk — as illustrated by the experience at the Fluvanna Correctional Center for Women, the report noted.

The corrections department has been under a consent decree since 2016 stemming from a federal class action lawsuit alleging inadequate medical care that was being provided by the contract health care provider at the prison.

“Compliance with the consent decree has resulted in health care spending at Fluvanna increasing from $11.4 million in 2016 to $23.4 million” in the year that ended June 30, wrote fiscal analyst David Reynolds. The department also has spent $2.8 million in legal fees generated by health care lawsuits since 2016.

The JLARC study found that health care vendors are generally unable to provide stable staffing and that facilities with high turnover rates have resulted in higher medical grievance filings. The department is trying to find ways to better manage the risks, Reynolds wrote.


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