NEWS

August 23, 2009
It's tough for terminally ill inmates to receive medical furloughs in Alabama

Almost a year ago Alabama passed a law that would allow terminally ill inmates a chance to die at home and, it was hoped, save the state a little money.

But the eligibility criteria for the new medical furlough are so strict that it could be a long time before the state Department of Corrections sees significant savings.
When Alabama passed its law last year, it became one of 36 states to provide a medical furlough for incapacitated or terminally ill inmates.

Ruth Naglich, associate commissioner on health services for the department, said when the bill was first proposed, 120 of the state's 25,000 inmates were identified, but that number shrank once the final law was in place.

In a year's time, the state has released three terminally ill inmates, and they were just released this summer.

The first medical furlough release, Omar Rahman, was so ill that he died 30 hours after his release. He was serving a life sentence and had been in prison since 1982, according to the department's records. The other two inmates who have been furloughed are alive.

So who's not eligible?

Sex offenders and those convicted of capital murder. "The number of prisoners eligible was brought down, particularly when they took out sex offenders," Naglich said. And even if you are an inmate who is technically eligible, no identifiable risks, no warrants in other states, no sentencing restrictions Naglich said the state is challenged to find somewhere to put you.

"Some inmates simply don't have any family left," she said. "And if they have family left, they might not have the means or ability to care for the individual as the bill requires."

In addition to ensuring that there is family willing and capable to take the inmate in, the state also is required to notify victims of the inmate's crimes.

"In the case of someone in prison for multiple burglaries, we have to contact every county where they had charges," she said. "And the victims get to have their say and understandably so."

Larry Spencer, an assistant professor of criminal justice at Alabama State University, said the drafters of the state's medical furlough program are cautious for a reason -- prisoner furloughs are risky business.

"The state is taking a chance to some extent," said Spencer, who worked for the federal prison bureau for 26 years. "You're putting an inmate into the community, unsupervised, and although they are sick you have to ask 'Would he pose a threat if he was released?' "

Spencer said he's not surprised that the state only has released three people under the new program.

"If something happens, the first thing that would be asked is who made the decision to let this person out," he said. "You don't want to pick up the newspaper or turn on the television and see that."

Spencer said the state has to look at a lot of different things to ensure that it is making the right call, including an inmate's criminal history, what type of adjustment the inmate made in prison and how sick he or she really is.

"This is one of those things that (the) state has put in place to alleviate the severe overcrowding, but the other factor is the cost for medical care," he said. "The cost of medical care can just tear up your budget." That's what it's been doing to Alabama's budget.

Naglich said there are 170 inmates who are suffering from a debilitating or terminal illness, but there are 6,000 statewide who are in some kind of chronic care clinic. She said a patient who receives dialysis three times a week and has other related illnesses costs the state between $60,000 and $65,000 a year.

An inmate with cancer might cost the state $68,000 and an inmate who has a stroke and must use a wheelchair for the rest of his or her life could cost the state an extra $45,000 to $50,000 because of extra staff, equipment and nutritional needs.

The medical furlough program is expected to help alleviate some of these financial burdens, but Naglich said it's tough and slow going.

"There are a lot of hoops, and we would like to see the process more streamlined," she said. "It's not as clear cut as 'Oh gee, this inmate is dying; just let him out.' The criteria is such that no one should be at risk."

Naglich said the department works with the state's pardons and parole board on this program, but there is a need to develop resources not only for inmates who are medically furloughed, but also even terminally ill inmates who complete their sentences.

Nursing homes and hospice facilities aren't eager to take in people who have criminal histories, she said.

"I do appreciate that there are folks in the community helping us with these furloughs because the department is so strapped," she said. "But if we're going to leave these folks in prison and the laws aren't going to change, we have to start thinking about how we can use our funding to provide the kind of facility that can care for them in a cost-effective way."

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