Davis, a tall white man with wispy brown hair and a chest-length gray beard, is serving 31-35 years in North Carolina for a truck accident that killed an elderly couple and severely injured their adult daughter in 2007. Late one evening, Davis’ flatbed Ford F-350 veered off the road and T-boned the family’s smaller Chevy S-10 pickup. Following the crash, Davis registered a 0.09 blood alcohol concentration at the hospital, above the legal limit of 0.08. This led to two consecutive convictions for second-degree murder, which makes up the bulk of his sentence.

Doctors diagnosed Davis with prostate cancer in 2019. Radiation treatment sent him into remission, but in 2022, the cancer returned, spreading to his ribs, collarbone, pelvis and lymph nodes.

“It’s stage four,” Davis said in a dayroom at Neuse Correctional, a medium-custody prison in Goldsboro, North Carolina. Davis also suffers from Type-2 diabetes, osteoporosis, arthritis and hypertension. To hear, he has to cup his palm around his ear. To get around, he needs the help of a wheeled walker. His very existence appears labored and excruciating. “At this point, they’re not trying to cure me. I’m beyond that. They’re treating me until I die.”

Davis is just one of about 31,000 North Carolina prisoners who racked up a $357.4 million bill for health care in fiscal year 2021-2022, an expenditure that ballooned 51 percent over the past 10 years, according to NC Health News. Nationally, U.S. prisons spent $8.1 billion on prison health care in 2015 alone, as reported by Pew Trusts.

In an attempt to reduce the cost of prison health care in North Carolina, the GOP-run legislature in 2023 passed changes that make early release for medical reasons less stringent. Governor Roy Cooper, a Democrat who just left office at the end of December, signed it into law.

Under North Carolina’s medical release program, prison medical staff or representatives of a prisoner such as a family member or attorney can request that prison officials evaluate someone for medical release. If officials determine that someone meets the criteria, they can refer cases to the state’s governor-appointed parole commission, which makes the final decision. 

The changes lowered the age at which prisoners can be released for medical reasons from 65 to 55. To qualify, the prisoner must be so terminally ill, disabled or geriatric that they are medically incapacitated and determined by officials to pose little to no risk to public safety. People serving time for murder, sex offenses, and other violent crimes still cannot apply.

Because of the second-degree murder convictions that resulted from his truck accident, Davis is not permitted to seek medical release in North Carolina. So he will remain in prison, incurring exorbitant fees for doctors visits and medication at taxpayers’ expense. Despite the disqualifications, Davis wishes he could be considered for medical release. “Because I’m dying,” he said.

Other states have medical release programs, and most codify variations of the same guidelines. All exclude people condemned to death row. On paper, New York allows infirm people convicted of anything besides murder to apply for release if they have served at least half of their sentence, yet prison officials routinely deny hearings for them to make their case. In Wisconsin, people with terminal illness whose sentences allow for parole can seek release after serving 10 years. Florida reserves the right to re-incarcerate someone previously released for medical reasons if doctors determine that their physical condition has improved.

The increase in life sentences that followed a wave of so-called tough-on-crime policies in the 1980s and 1990s has resulted in a graying of the U.S. prison population, leading to swelling medical costs that states are now struggling to address. As reported in the New York Times, the number of people aged 55 or older in state prisons increased by 400 percent between 1993 and 2013. That group will make up one-third of the nation’s prison population by 2030. Since 1976, the Supreme Court has considered the denial of health care to sick prisoners a violation of the 8th Amendment, regardless of whether they are serving six months or condemned to death row. 

In North Carolina, too, around 17 percent of state prisoners are over 55. Those older people already cost the state four times what it spends on younger individuals, according to research published in the National Library of Medicine. 

Sandra Hardee, Secretary of NC-CURE, helped push lawmakers to expand North Carolina’s medical release law in 2023, lobbying alongside other groups like the North Carolina Justice Center and Conservatives for Criminal Justice Reform.

Hardee said the money that lawmakers envisioned saving in the long run by expanding medical release was key to them approving the new measures. “Before the new law passed,” Hardee said, “Health care for some inmates was costing $1 million a year.” 

According to reports from the North Carolina Department of Adult Correction (DAC), the number of people prisons have referred for medical release has dropped significantly in recent years. In 2021, prisons referred 39 cases to the parole commission, which ultimately granted medical release for 29 people. In 2022, prisons only referred 10 people to the parole commission, which granted medical release to just seven people. In 2023, prisons referred only eight people to the parole commission; three were granted medical and one person was denied, while four others died in prison awaiting a decision. 

DAC has yet to release its report covering the first year of expanded eligibility.

Although Hardee is pleased lawmakers expanded who is eligible for medical release, she says there are still barriers to actually releasing terminally ill people who qualify.

As it stands, no individual or board is tasked with identifying eligible prisoners for medical release, meaning people must find a way to apply on their own. If their family cannot afford legal counsel or don’t have other outside help, the prisoner must handwrite the paperwork themselves. Some prisoners may be too sick to physically file a request on their own.

“Right now, there are about 1,000 people that could be qualified by age and crime,” Hardee said. “If they were released, it would be a step in the right direction, but there is no way to identify them.”

Yvette Garcia Missri, executive director of the Wilson Center for Science and Justice at Duke University’s law school, helped lead the coalition lobbying for the 2023 changes to medical release. Even with expanded eligibility, Garcia Missri says that doesn’t mean all people who qualify are granted release. She said prison officials have seemed to focus on releasing “terminally ill” people, but not those who fit other categories such as “geriatric or permanently ill.” 

“One of our goals is finding ways we can work with DAC to get full usage of the law so that everyone is included,” Garcia Missri said. Part of this goal means defining key terms within the law, such as “medically incapacitated.” “Currently this term is left for DAC interpretation, which could be exclusionary,” Garcia Missri said. If people are not considered medically incapacitated beyond survival, they may not be released early. She hopes that offering clear definitions of the law’s requirements will make it less limiting, reducing the number of people excluded.

Aside from the challenges of seeking release, the new law will only benefit a fraction of the prison population. Its limitations exclude younger prisoners, even those with enormous medical needs.

In 2015, 22-year-old Michael Helms was diagnosed with Crohn’s disease, a chronic inflammation of the gastrointestinal tract that causes intense cramping and diarrhea. Convicted as a teenager, Helms was a few years into a 28-year sentence for second-degree murder and conspiracy to commit murder.

“[Crohn’s] is not harmless,” Helms said while sitting in the yard at Nash Correctional, a medium-custody prison in Nashville, North Carolina. “I’m lucky they put me on the right meds. If not, bacteria could have escaped my intestine to cause sepsis.”

This year, Fox News labeled sepsis a top killer behind heart disease and cancer, taking the lives of “350,000 American adults each year.” 

Helms is too young, and, by the standards of the new law, still too healthy and his murder conviction too serious to make him eligible for medical release.

For treatment, prison nurses administer Helms one shot of Humira bi-weekly, but it’s not cheap. At nearly $4,000 a month, Helms’ treatment has already cost taxpayers about $600,000 since his diagnosis nine years ago. His treatment will cost another $720,000 before his projected release in 2040, totaling $1.3 million throughout his incarceration. That figure is added to the $133 it costs to incarcerate one person per day in the state, as noted by the DAC.

Now 31, Helms is healthy and focused on positive personal change. If he had been convicted 30 years ago, his clean prison record would have helped him earn parole so he could eventually get out and help pay his own medical bills. But North Carolina eliminated parole in 1994 by implementing the Structured Sentencing Act, a sentencing structure that imposes an 85 percent mandatory minimum on all active prison sentences. 

A report published on JSTOR credits mandatory minimum sentencing as responsible for a spike in the national prison population. Earlier this year, the North Carolina Sentencing and Policy Advisory Commission projected that, on average, people imprisoned under the Structured Sentencing Act “will serve 104% of their minimum active sentences,” keeping prisons full of people who will cost more to care for as they age.

James Davis wasn’t sentenced to die in prison. He has a release date. If he were younger and healthier, he’d most likely live to 2039, when he’s eligible for release. Or if the judge had sentenced him concurrently, meaning his sentences would run together and not consecutively, he would be released in 2025 after finishing his longest sentence. Instead, Davis must remain in prison until he dies.

Although Davis is dying from cancer, he knows that he is ineligible for medical release. He won’t sue the state to challenge the new law’s exclusionary rules. His own guilt is partly the reason.

“Two people died, you know, and it’s my fault,” he said, slouching over his walker. “I been here 16 years. I lost my dad, my wife, my brother; I lost a lot of people I loved, so I understand the pain I caused,” he said, lowering his head in thought. When he raised it again, his old eyes glistened with tears. “I wish I had died in the accident. Not them.”

*Correction 1/10: A previous version of this story misstated changes to the medical release law.

The post Terminally Ill People Languish in North Carolina Prisons, Even After Reforms appeared first on Bolts.

When Kendra Drysdale was groped by a prison guard during a pat-down, she knew that reporting it internally within her facility, the federal prison FCI Dublin, would only make things worse. So she emailed a report to what she thought was a direct line to the Department of Justice. But Dublin leadership caught wind of the email, accused her of lying in order to file a false report, and ordered her into a disciplinary hearing. 

“What do you want to keep?” Drysdale remembers an officer asking her during the disciplinary hearing. She thought immediately of her 22-year-old daughter, who’d lost her dad and had only her to rely on, and asked through tears to keep access to phone calls so they could still communicate. “And she said, ‘Okay, I’m taking your phone. I’m taking your email. I’m taking your video visits, I’m taking your in person visits,’” Drysdale recalled. The prison also took away her job, her access to commissary, and, most crushingly, her early release credits, leaving her in prison for several months past the date she was supposed to go home.

Drysdale’s story is just the tip of the iceberg at FCI Dublin, the now-notorious federal prison in Northern California whose employees preyed on the prisoners in their custody for years in a culture so pervasive that prison staff nicknamed it “the rape club.” The chaplain was abusing women. Medical staff were abusing women. The warden, who had trained staff on the Prison Rape Elimination Act, was abusing women. 

At FCI Dublin, “Everybody knew something, everybody had observed something,” said Tess Korth, who worked as a correctional officer at the prison for 25 years until she says she was forced out for calling out the abuse. “In my opinion, they enabled all this stuff to continue going on.” Internal attempts to address the situation went nowhere: 

Korth told Bolts that she made reports of the abuse within the Bureau of Prisons (BOP) for six years, starting in 2016, with no results.

These violations finally came to light in 2021 after an investigation by the Department of Justice, which oversees the BOP, led to the indictment of a guard. Eventually, seven FCI Dublin employees, including the warden, were convicted of sexual abuse (an eighth will stand trial next year). In February, the California Coalition of Women Prisoners (CCWP), a member of the Dublin Prisoner Solidarity Coalition, filed a class-action lawsuit against the BOP. This past March, a federal judge appointed a special master to look into the allegations, which advocates hoped would bring some measure of oversight. Then, in April, the BOP announced it was closing the facility entirely. 

Drysdale and a few others whose sentences were ending were released, but nearly everyone else was transferred, sent to over a dozen different federal prisons throughout the country, some thousands of miles from their family and children. Women were retaliated against further on the drive there, as Lisa Fernandez, who has covered sexual abuse at FCI Dublin since early 2022, reported recently for Rolling Stone; many face ongoing retaliation at their new facilities.

It’s difficult to imagine a more serious abuse of power than a prison guard who preys on a person whose every action he already controls—her communication with the outside world, her visits with her family; her access to food, supplies, showers, medical care. Federal prison officials allowed this type of abuse to go on unchecked for years. Now that the story has broken open, the litigation, prosecutions, and efforts to establish broader federal oversight are really attempts to answer one central question: What does an appropriate remedy look like? 

Lately, lawyers representing the survivors are trying a novel strategy: compassionate release. The mechanism, generally conceived of as a last-resort option for dying or medically incapacitated prisoners, is for the first time being considered as a reparative measure for women who were sexually abused while in federal custody. 

“We thought, what’s more extraordinary and compelling, which is the standard for compassionate release, than being sexually abused by prison guards after your sentence has been imposed?” said Shanna Rifkin, deputy general counsel for Families Against Mandatory Minimums (FAMM), who is spearheading the effort. “No federal judge sentences people to be sexually abused in prison.” 

FAMM and the pro bono lawyers working with them have helped secure compassionate release for 17 former inhabitants of FCI Dublin thus far, and they’re evaluating 95 additional requests for legal aid from women formerly held at the facility. But seeking this remedy has come with its own challenges—ones that underscore precisely why it’s so difficult to eradicate sexual violence in prison. 

The Department of Justice has stressed that it is seeking long sentences for prison employees charged with these crimes. In response to a request for comment, a DOJ spokesperson emphasized the 20 BOP employee prosecutions the Department has brought since January 2021, and wrote in a statement that “The Department of Justice has and will continue to prioritize seeking justice for victims of sexual assault by FBOP employees.” But survivors and advocates say that prosecution alone, fails to help victims of sexual abuse heal—nor does it stop the harm at its root, given how far the cover-up and retaliation at FCI Dublin extended beyond the officers charged with criminal offenses. 

“The issues at Dublin really had a spotlight on them for good reason, but the issues run all the way up the ladder to the highest points of BOP,” said Courtney Hanson, the development and communications coordinator for the California Coalition for Women Prisoners. Given that sexual assault in federal prison is widespread, FAMM estimates many more people could be eligible for compassionate release around the country. 

Bolts reviewed data compiled by CCWP on the current whereabouts of more than 100 women who were being held at Dublin when it closed, and found that the vast majority were transferred to other federal facilities with a documented history of sexual abuse by guards. “It’s prevalent through the whole BOP,” Drysdale said. “They’re not safe anywhere.”

Since Congress established federal compassionate release via the Sentencing Reform Act of 1984, the process has been open to anyone who can prove an “extraordinary and compelling” reason that they should be freed before the end of their sentence—at least in theory. In practice, compassionate releases are rare, though a 2018 reform that allowed prisoners to petition the courts themselves led to a sharp increase in the number of applications, especially after the COVID-19 pandemic began.

FAMM has long pushed for reforms to the compassionate release process at both the federal and state level, where access can be even more patchwork and dysfunctional. After the revelations of widespread abuse at FCI Dublin, Rifkin helped convene a group of pro bono lawyers to bring compassionate release cases before federal judges. They argued that sexual abuse in custody should qualify as a reason for release—both as a concrete reparative measure the government can offer, and as a necessary precondition to healing—and many of the judges agreed. 

Seventeen former FCI Dublin prisoners have now won their freedom after arguing that the sexual abuse they experienced in prison constituted an extraordinary and compelling change of circumstances. The road ahead is by no means easy, but Rifkin noted that release has allowed women to reconnect with their children and access resources like peer support and therapy. “Just being able to be outside, just being with your family—there’s a lot that that offers,” she told Bolts.

To Kelly Savage-Rodriguez, who worked to reform state-level compassionate release in California in 2022 and now works with CCWP, the reasoning behind release is simple. “You can’t get healed and deal with the trauma of that sitting in a cell,” Savage-Rodriguez told Bolts. “You need to be able to get counseling… not be told to shut up and sit down and this is why we’re gonna punish you more.”

In order to facilitate these individual compassionate release applications, FAMM sought to enshrine the principle that sexual abuse in custody qualifies as a reason for release within federal sentencing policy. To do so, they had to go through the people who decide what “extraordinary and compelling” means: the U.S. Sentencing Commission, an independent federal agency made up of seven presidential appointees. (Its most famous recent alumna is Supreme Court Justice Ketanji Brown Jackson).

Douglas Berman, a professor at Ohio State University’s Moritz College of Law and the author of the Sentencing Law and Policy blog, told Bolts that the commission has an enormous amount of influence over sentencing policy, even as it has historically chosen to take a modest and conservative view of its own power. “I think it could do an awful lot and dramatically shape many aspects of our nation’s criminal justice systems,” Berman said. “But even in its more sort of focused role that it’s adopted, the federal sentencing guidelines are still central to literally every single federal sentencing that takes place—and that’s upwards of 60–70,000 persons every year.”

Starting in early 2019, the Sentencing Commission lacked a quorum after two rounds of Trump nominees proved too controversial for Senate confirmation (one, a federal judge known as “Hang ‘Em High Henry,” once said “I live to put people in jail”). For several years, nothing got done. But all seven of Biden’s nominees eventually proved more successful, and by mid-2022, the commission was back in action with four Democrats and three Republicans, in keeping with requirements to seat no more than four members of the same party. 

In April 2023, after FAMM’s request, the commission significantly expanded eligibility for compassionate release, including adding sexual abuse in custody as a criteria. It seemed like a victory—but it was actually about to make winning compassionate release even more challenging for survivors.

At the DOJ’s behest, the sentencing commission added two hurdles that people sexually assaulted by prison employees have to clear in order to be considered eligible for compassionate release: The sexual contact must be penetrative, and proof that the abuse occurred must come in the form of a criminal conviction, a civil admission or finding of liability, or an internal administrative finding. These changes took effect on Nov. 1, 2023. Berman said this sort of deference to the DOJ is not uncommon, even though this commission is notably more progressive than past incarnations. “Under any leadership, under any structure, we’ve long seen the Department of Justice and its voice find significant attention in the work of the Commission,” he told Bolts. 

But Rifkin says these hurdles ignore the reality of what sexual violence in prison looks like and how it’s adjudicated. “Many of the people at Dublin were sexually abused in a way that was intense stalking and harassment and abuses of power, but not penetrative genital contact,” she told Bolts. “We have a lot of people for whom a guard would stand outside their cell and say, ‘I’ll only let you use the shower if you take off your shirt and flash me’ or, ‘I’ll only let you leave and go to the lunch line if you touch yourself in front of me.’” 

The admission of liability requirement also runs counter to the way that sexual assault claims are often handled by the BOP. A 2023 investigation by The Appeal, for instance, found that many civil cases alleging abuse at another federal prison, FCI Tallahassee, were settled out of court. 

Ironically, after the new sexual assault criteria became effective, Rifkin said, these compassionate release applications faced a steeper uphill battle than when there were no criteria in place at all. “After November 1 and this new policy statement, we’ve seen many federal prosecutors who are really kind of digging their feet in the sand and saying, ‘If you don’t meet these exact standards, we’re not going to agree to the case. And we will oppose it,’” she told Bolts. 

Rifkin said that FAMM will be petitioning the Sentencing Commission to reconsider the evidentiary hurdles, highlighting their “unintended consequences.” But she stressed that it’s well within the DOJ’s power to “make clear to U.S. Attorneys Offices across the country that they should be cooperating with survivors of abuse and their attorneys to help move these cases forward.”

Bolts asked the Department of Justice whether the agency has given U.S. attorneys’ offices explicit guidance on how to approach compassionate release cases that involve sexual abuse in custody, and for a response to FAMM’s pushback on the evidentiary hurdles. A DOJ spokesperson responded, “While only a federal court can grant a petition for compassionate release, the Department fully supports the FBOP Director [Colette S. Peters] as she continues to move for compassionate release for victims in appropriate cases.” Sentencing Commission data for Fiscal Year 2023 shows that Peters used her authority to bring just 7 of the 431 compassionate release petitions that a federal judge ultimately granted (There is no indication of whether any of those 7 were victims of sexual abuse by prison staff). 

In a statement to Bolts, a BOP spokesperson said, “The FBOP is prioritizing compassionate release for victims of sexual abuse by FBOP employees. While the FBOP can’t directly reduce sentences, we recommend eligible individuals to the U.S. Attorney’s Office. The FBOP is also revising the Compassionate Release policy to broaden eligibility.”

If the Sentencing Commission reconsiders the evidentiary hurdles, it could pave the way for a slew of new compassionate release cases; Rifkin says there’s no telling just how many federal prisoners might be victims of sexual abuse by BOP employees. Besides the 95 cases it’s evaluating from FCI Dublin, FAMM and its network of lawyers have accepted five compassionate release cases on behalf of women incarcerated at FCI Tallahassee, where sexual abuse has been reported for decades. (At least three guards have been indicted in the past two years; and the prison was the site of a shocking shoot-out in 2006, when a guard indicted in a sexual bribery scheme opened fire on federal agents who had come to arrest him and five of his colleagues).

In December 2022, a congressional probe led by Georgia Senator Jon Ossoff found that sexual violence is rampant in federal custody. “The BOP is failing systemically to prevent, detect, and address sexual abuse of prisoners by its own employees,” Ossoff said during the hearing, calling the culture of abuse “cruel and unusual punishment.” A bill resulting from this research, the Federal Prison Oversight Act, passed the U.S. House in May.

Before she was transferred to FCI Dublin, Kendra Drysdale spent 11 months at the Federal Medical Center, Carswell, in Texas, where she says sexual abuse by guards, and retaliation for reporting it, was also rampant. Scores of women at Dublin have since been transferred to other federal facilities with documented histories of guard sexual abuse, including Carswell. And women have reported retributive solitary confinement, strip searches, medical neglect, denial of food, and verbal abuse at their new prisons. “There’s sexual assault victims all over the country right now being severely retaliated against—ongoing, ongoing, ongoing—because they spoke out,” Drysdale said. 

Since her release in April, Drysdale has thrown herself into the process of recovery. “I went in diagnosed with compound trauma disorder, and I came out of it feeling like I just got more and more trauma than I ever had,” she told Bolts. She said she is lucky to be able to stay with family on a farm in the Santa Cruz mountains, where she tries to push herself to explore nature, despite naturally gravitating toward the studio apartment she sleeps in after spending years in a cell. She has found a therapist and other peer support. She finds herself crying a lot these days, which she takes as a sign that she finally has a safe place to begin to process everything she went through. 

And Drysdale has begun working with the Dublin Prisoner Solidarity Coalition to advocate for women’s rights in federal custody, which she sees as a crucial component of her recovery. “Doing this helps me get better because I know I am doing what I can to help others still suffering,” she told Bolts. 

The FCI Dublin developments come as state and local prison and jail systems also fail to prevent sexual abuse by employees within their walls. The Texas Office of the Inspector General has received more than 600 complaints of sexual abuse by prison guards over the past five years, Texas Public Radio reports. In New York, the Adult Survivors Act has paved the way for more than 700 lawsuits over alleged sexual abuse at Rikers Island. 

And the California Department of Corrections and Rehabilitation is currently facing its own scandal over sexual abuse in custody. This January, attorneys filed a lawsuit on behalf of over 130 women who say they were abused in custody at California’s two women’s prisons; one guard allegedly assaulted more than 22 women over a decade-long span and now faces 96 abuse charges. As with the federal Bureau of Prisons, CDCR has been reluctant to consider releases as a remedy for survivors of sexual abuse, CCWP’s Savage-Rodriguez said. 

Meanwhile, organizers with the Dublin Prisoner Solidarity Coalition say they will keep fighting for releases, along with a host of other protective measures, for everyone transferred out of FCI Dublin this spring. Hanson said that CCWP’s work has shown that the problem of sexual abuse within prison is fundamental to the institution of prison itself. “In every single carceral institution where we’ve ever worked with people, we hear stories of gender violence and assault,” she told Bolts. “While Dublin has been a particularly egregious example, we think ultimately, we need other systems of care and accountability altogether.”

Updated (July 8) with comment from the Bureau of Prisons.

The post “What’s More Extraordinary and Compelling?” appeared first on Bolts.

One of the first things they saw when they walked into the prison was the wheelchairs. 

One after another, something like 40 chairs and walkers were lined up neatly outside each cell, stretching away into the distance. It was a jarring sight even for Kyle Hedquist, who’d worked for many years as a hospice volunteer during the decades he spent locked up there. 

Hedquist never thought he’d get out of prison. When his sentence was commuted in mid-2022, he certainly didn’t expect to be back so soon. But in mid-January, he found himself on the Oregon State Penitentiary’s E Block, this time accompanied by high-ranking prison officials and a dozen state lawmakers—all staring at this endless line of equipment for prisoners who were too elderly or sick or disabled to walk on their own. 

It was a powerful testament to an uncomfortable truth about America’s prisons: Increasingly, they contain elderly people, who are serving life or many decades for crimes that were adjudicated in the wake of the United States’s turn towards harsh sentencing schemes like mandatory minimums and three-strikes laws. Many of these people will die inside-–despite the fact that nearly every state possesses some form of compassionate release program that could allow terminally ill prisoners to spend their final days at home.

Oregon has a higher percentage of aging prisoners than most states. Hedquist was there that day to show legislators the prison infirmary where he had worked, in hope that they might support legislation, Senate Bill 520, that would overhaul the state’s compassionate release system. Hedquist was hired after his release as a policy and outreach associate by the Oregon Justice Resource Center, an advocacy organization that has been trying to improve the compassionate release process in Oregon for years.

Families Against Mandatory Minimums, a national organization that supports criminal justice reforms, has been researching the issue for almost two decades, discovering that in almost every case, compassionate release is more of an idea than a reality. Last year, the organization released a report grading each state’s compassionate release system. Amidst generally poor results, Oregon failed in every category that FAMM used to measure systems—scoring higher than only five states, including two that had no compassionate release programs at all at the time. “It’s kind of a bare bones system,” said Daniel Landsman, FAMM’s deputy director of state policy. “It just falters in every category.” 

According to data FAMM obtained from the state’s department of corrections, only seven out of 47 applicants won compassionate release in Oregon in 2019, while six people who had applied died before their cases could be processed. In 2020, no one who applied got out via compassionate release. 

“We would say that those low numbers don’t reflect how many people are discouraged from even trying to apply by the complexity of the system, how opaque it is, the lack of a clear path through it or timeline,” said Alice Lundell, OJRC’s director of communications. “It’s very difficult to quantify how many people are just not even attempting this because it is beyond them, particularly in a very poor state of health to even begin.” 

Applicants are first required to be terminally ill or elderly and medically incapacitated to qualify, though no definitions for these terms are supplied. These extremely sick or dying people must initiate the compassionate release process themselves and then complete a lengthy and complicated petition on their own that involves a medical report documenting their condition, a detailed post-release plan including treatment and housing, and a personal recommendation from the prison superintendent. 

In the unlikely event they clear each of those hurdles, their petition arrives at the state’s board of parole, which in any given term, “may or may not have a medical professional on the board—usually they don’t,” says Hedquist. “They’re only looking at the crime, saying, ‘Well, hey, this dude’s got a 40 year sentence for A, B and C. We’re not going to let him out.’” 

Aliza Kaplan, who runs the Criminal Justice Reform Clinic at the Lewis & Clark Law School, says the prison superintendent recommendation requirement in particular makes it extraordinarily difficult to advance past that point in the process. “We are lawyers who have a lot of access and know people—and we couldn’t get anyone to write us back or talk to us about our cases,” she told Bolts.

Kaplan’s clinic has stopped even trying to use compassionate release as a mechanism to get people out of prison. The enormity of the system’s failure became particularly stark during the pandemic. “My law school was shut down,” she said. “I was sitting in my office anyway. And I was being inundated with letters and phone calls from folks in prison and family members afraid that their loved ones were going to die.” She went on: “There was nothing to even offer people because I knew that the law on the books, the compassionate release law, was never going to help them.” 

In a 2019 essay for PEN America’s Prison Writing Contest, Hedquist detailed his experience working in hospice. “Death, I would learn, comes on its own terms and in its own time,” he wrote. But the urgency that attends the last few months of someone’s life is nowhere to be found in the compassionate release system. “The board of parole gets to these cases when they get to them,” said Zach Winston, OJRC’s policy director. 

SB 520, the proposed compassionate release legislation, seeks to revamp the compassionate release process to make it more of a viable option. First, it creates a duty for prison officials to recommend terminally ill people with less than a year to live for compassionate release, taking the onus off of the critically ill person themself to start the process. It also gives doctors more control over the process, establishing a board of medical professionals to evaluate compassionate release requests, and attempts to crack down on the mechanism’s delays by requiring the board to rule on applications within 45 days, or within 14 days if the applicant has a prognosis of less than a year to live.

The doctors’ recommendation would have greater weight in the final outcome by setting a higher burden for carceral officials to overturn it: Landsman said the bill would establish a “presumption of release to people who have been proven by medical professionals to truly be terminally ill or medically incapacitated.” People could still get denied if they were found to be a danger to public safety or, more likely, didn’t have a robust post-release plan. 

Oregon Physicians for Social Responsibility, an organization that works on public health and social justice issues, is also sponsoring the legislation. “This bill ensures that Oregon’s compassionate early medical release process is health-centered and that [adults in custody] can better exercise their right to access the medical care and treatment that they need,” the group told Bolts in a statement. 

SB 520 was reintroduced in Oregon’s legislature for the 2023 session after failing to pass in 2021 and 2022. Oregon Republicans denounced the legislation for “letting people out of prison,” stripping it of the end-of-life context, which advocates say proved damaging to their efforts amidst the glut of soft-on-crime attacks on Democrats in advance of the national midterm elections. But Oregon Democrats defended the governor’s mansion and their large legislative majorities in November. 

One sticking point for the compassionate release bill last session was its budget. Proponents make the point that the bill would save money for the state by shifting the burden of paying for the care of sick and dying people in prison. “Prisoners are not eligible for their veterans benefits, and many of these guys are veterans,” Hedquist said. “Prisoners are not eligible for Medicare, Medicaid, because they’re incarcerated. And so these are direct tax dollars.” But Winston of OJRC said that the bill had been hindered in prior sessions by estimates that it would require new staff to implement. 

 There are bills to reform compassionate release pending in a handful of other states this year. Illinois established a new mechanism for the first time in 2021, leaving Iowa as the only state without one, and California overhauled its compassionate release system last year to enable more people to leave prisons. Still, many states’ compassionate release systems remain barely functional; past reporting by Bolts and New York Focus has found that a few prison officials in New York State routinely deny hearings to terminally-ill New Yorkers, for instance.

Like California’s new law, where prisoners serving life without parole remain ineligible for compassionate release, some Oregonians still won’t be able to access compassionate release even if the legislation passes. People convicted of any of 21 crimes that fall under Measure 11, a mandatory minimum ballot measure approved by voters in 1994, are categorically excluded. Amending Measure 11 would require a two-thirds majority in the state legislature, though Hedquist called the carve out “a bitter pill.” 

There could be other barriers as well. With the departure of Kate Brown, the term-limited governor who greatly expanded clemency, and a good deal of rookie lawmakers who may not be versed in the nuances of crime and prison policy, Kaplan is worried that criminal legal reform bills won’t be a priority this session. SB 520 is currently sitting in the Senate’s healthcare committee. 

“A lot of new legislators means that those of us who do criminal justice work need to spend time educating people and you know, it’s going to make all criminal justice legislative matters harder this year,” she said. 

That was the point of getting lawmakers to visit the prison infirmary, Hedquist says. “Unless you have a loved one in prison, you almost have zero connection to the prison,” he told Bolts. “And so when you talk about voters, when you talk about senators—if they don’t know someone in prison, they just don’t know. And you can’t pass good legislation if people don’t know.” Many of the lawmakers, he suspected, had never been inside a prison. It was just an abstraction for them, a matter of policy.

For Hedquist, it was anything but abstract. It was ten people dying a month of Hepatitis C in the ‘90s; it was bathing dying lifers, playing cards with them, hearing their deathbed confessions. “Hospice was really the place where you could strip away all that prison was or all that prison tried to make us be and just be human to human,” he said. 

He wanted to make that a reality for the lawmakers too. “It’s almost like once you see it, you can’t unsee it,” he went on. “So if anything, some of these folks are going to be in a position where they can’t just close their eyes and turn their head and say, ‘Well, I’m sure DOC will figure it out.’”  

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For four years, Kelly Savage-Rodriguez helped women die in prison. As a volunteer comfort care worker at the Central California Women’s Facility, informally known as Chowchilla, Savage-Rodriguez played a hybrid role: somewhere between a hospice nurse and a proxy for patients’ family members. She brushed their hair, played cards with them, helped them write letters to their loved ones outside prison.

California has a program called compassionate release that allows the courts to grant people who are dying in prison their freedom, but a system of arbitrary delays and denials means that it rarely happens in practice. “The hold-up is so extreme,” recalled Savage-Rodriguez, who was released in 2019 and is now the Drop LWOP coordinator for the California Coalition for Women Prisoners (CCWP). “We would sit there watching day after day—family members calling, fighting to try to get information and hearing nothing—only to be told that [the request] never even left the institution.”

The California legislature passed a bill on Tuesday that aims to improve the compassionate release process, and it’s now awaiting signature by Governor Gavin Newsom. Assembly Bill 960 would expand eligibility for compassionate release, streamline the approval process, and automatically provide legal counsel. The bill is sponsored by Assemblymember Phil Ting and a broad coalition of organizations, including CCWP, UnCommon Law, and Families Against Mandatory Minimums (FAMM). 

“When I think about somebody dying in there, it hurts,” said Savage-Rodriguez. This bill, she said, “could give them just that moment of peace with their family.” 

Some California organizers hope that this new bill clears the way for a broader reconsideration of how the state treats its aging, ill, and medically vulnerable prisoners. In a particularly dark legacy of the harsh sentencing laws of the 1980s and 1990s, the very same people sentenced under mandatory minimum guidelines and handed lengthy enhancements in their teens and twenties are now growing old and sick in prison. Unless something changes, many of them will die there.

There are two standard routes for someone to be released from prison for medical reasons in California: compassionate release and medical parole. The initial version of AB960, introduced by now-state Attorney General Rob Bonta in 2021, focused on improving the latter: Medical parole is decided by the parole board, not the courts, and funnels people into licensed skilled nursing facilities across the state rather than releasing them into the community. But issues with the system kept surfacing. “It’s not only that people on medical parole aren’t really released, they can be sent back to prison for virtually anything,” said Leah Daoud, a policy manager for the legal and policy advocacy organization UnCommon Law. Then, in late 2021, federal health regulators found that California’s medical parole system violated federal standards for patient rights. Rather than change its practices to comply, California started sending almost all of its medical parole patients to a decertified facility where some patients were handcuffed to their own beds or neglected for hours on end. The state also began limiting future eligibility for the program to people on ventilators. 

From the sponsors’ perspective, the desired outcome of medical parole was no longer viable or desirable, so reforming the process seemed futile. They recalibrated their legislative push to focus on compassionate release. “Compassionate release in California has never been seriously studied,” said Daoud. “There really hasn’t been—up until now, with this bill—anyone looking at this process and saying, why is it that this happened or this didn’t happen?” They discovered that the existing process wasn’t working. In 2020, the legislature had amended the penal code to open up compassionate release to anyone who qualified for medical parole because of permanent medical incapacitation, but in practice, Daoud told Bolts, many people in that category still weren’t being considered. 

And those who did manage to register a request faced roadblocks throughout the process. Between January 2015 and April 2021, according to an analysis by FAMM, 304 people sought compassionate release. 290 of them were found medically eligible, but only 53 were released in time to pass away at home. 91 people died in prison, waiting. 

When you’re terminally ill, the importance of each passing second becomes agonizingly heightened. But that critical element—how much time you have—is often impossible to predict. “There’s no science to when somebody’s going to pass,” said Savage-Rodriguez. Rather than trying to attach eligibility to the number of months that someone has left, as the state currently does, AB 960 proposes a broader definition: anyone with an incurable condition or an “end-of-life” trajectory is eligible to apply. 

Moreover, the bill would accelerate the timeline for compassionate release, requiring the California Department of Corrections and Rehabilitation (CDCR)to refer a case to the courts no more than 45 days after the patient’s physician triggers the compassionate release process. It would also tweak the standard for the courts in favor of release, unless the patient can be deemed a risk to public safety. (Recidivism among elderly incarcerated people is extremely low. One study found that only 11% of people aged 65 and older reentered prisons after release.) 

Crucially, the new bill would remove the CDCR Secretary, an office that FAMM found to be the most likely source of denials, from the process entirely. Currently, the secretary must sign off on an application before it goes to the courts, an extra step that advocates argue is superfluous and produces inexplicable denials. “It was really clear that the secretary doesn’t play a medical expertise role in the process, they’re obviously not a trained medical professional—but they’re also not a public safety role either, that’s the role the courts play,” said Daoud. “All we’re doing here is giving medical professionals more ownership and power over this process, which is just what they should have had in the beginning.” (CDCR did not respond to a request to clarify the secretary’s role in this process). 

Before his retirement last year, Peter Eisenberg was a longtime medical oncologist at Marin Cancer Care. Eisenberg and his colleagues treated people incarcerated at San Quentin State Prison for cancer and a variety of blood diseases, and he saw firsthand how bureaucratic inefficiency prevented his dying patients from going home to their families. “I was kind of surprised that if I predict that the guy is sick enough to die of his, for instance, metastatic prostate cancer, that it would take so much effort and so long to get the paperwork, for crying out loud, to accommodate his death outside of prison,” he told Bolts. “I’d write in my notes that this person is likely to die within the next six months, and I’d write it over and over again.”

Eisenberg recalled a rare instance where one of his patients was released on parole; later he thanked his former physician for treating him with dignity and respect. “That’s nice to hear, but it’s my job,” Eisenberg said. “And I think it’s the state’s job to do the humane thing for people who have limited time on earth who are incarcerated for one thing or another…Weighing the appropriateness of an early release from prison because of their health issues shouldn’t be a bureaucratic battle. It should be a pretty simple thing to figure out.”

Thus far, AB 960 has encountered little pushback. Only one group—the California District Attorney’s Association, which tends to take issue with any reforms that aim to get people out of prison—has registered its opposition. Daoud said she’s hopeful that Newsom will sign, though the governor has not indicated his final intention. 

Proponents of AB 960 recognize that its adoption would still leave a lot of work. The bill can’t fix the United States’ broken healthcare system, for one. A particularly cruel irony is that some people may have better access to care in jail than on the outside. The lack of a solid post-release plan—strong family support, or a skilled nursing facility that has agreed to take on a patient—is the second most common reason that people who are medically eligible get denied from compassionate release, and AB 960 won’t address that. 

There’s also the issue of carve-outs. People serving a sentence of life without parole have never been eligible for compassionate release, along with those serving a death penalty sentence and anyone convicted of killing a police officer. That group includes women Savage-Rodriguez knew at Chowchilla who require regular care owing to unmanaged diabetes and a medication-induced stroke.

It also includes the woman who started the hospice program at Chowchilla back in 2000, after a spree of deaths in the prison left people stunned and grieving and spurred her to act. Judi, who asked that her last name be withheld to protect her family’s privacy, had no reason to believe she was ever getting out of prison. “I wanted to do something for the woman who were dying,” she told Bolts. “And actually for myself, because I didn’t want to die alone.” 

Thanks to Judi’s efforts, comfort care has been operational at Chowchilla for over two decades. She looked after dozens of women in the last days of their lives. “It was like that movie ‘Groundhog Day,’” she told Bolts. “It happened over and over.” For the ones who were eligible for compassionate release, she said, “It was almost universal that they died before they could get out.” 

Against all odds, Judi’s life without parole sentence was commuted several years ago. “Every day I wake up and I go: really?” she said. “I’ve been out three years and I still do that.” But a sentence commutation is like winning the lottery, and there are many more people growing old and sick in prison whom compassionate release doesn’t cover. 

“Statistics show that the recidivism rate [for aging people] is so minute,” said Amber-Rose Howard, the executive director of CURB, a coalition that aims to reduce incarceration and close prisons across California. Howard highlighted the need for elder parole expansion. But she also called for the state of California to change the policies that have people aging while incarcerated in the first place. “We have to think about the 25-to-life sentences. We have to think about these things that give people extra time in prison, and we have to reverse those policies. I think that’s the only way we’re actually going to see real change.” 

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If anyone were too sick for prison, Jose Medina thought, it would be him.

Medina was 27 years old when he entered New York’s prison system. Four decades later, at 68, he’s still behind bars—and afraid that he may die there.   

In 2005, he was diagnosed with lung cancer, which necessitated a complete removal of his left lung and a partial removal of his right lung. He survived the cancer, but was left with chronic respiratory disease and severe emphysema. He now depends on inhalers and, at times, a breathing machine. The following year, he applied for medical parole.

His request was denied. 

In 2014, doctors diagnosed Medina with prostate cancer. He now needs a catheter and multiple medications. Five years later, in 2019, the Defenders Clinic Second Look Project at the City University of New York submitted an application for clemency, or a request to the governor to shorten his 50-to-life sentence, on Medina’s behalf.

He never received a response, not even an acknowledgement of receipt. His legal team, headed by Steve Zeidman, sent a follow-up letter on March 16, 2020, two days after the first Covid death in New York—of a woman who, like Medina, had emphysema.  

“There’s every indication that he’s the exact sort of person to be most terrified about Covid. He told us he wouldn’t even leave his cell, he was just that terrified,” Zeidman said.

Four days later, the legal team sent another letter, this time requesting medical parole. 

On May 15, the prison agency denied the request. “It has been deemed that he is not an appropriate candidate for Medical Parole,” stated the letter, signed by the Department of Correction and Community Supervision (DOCCS)’s chief medical officer John Morley. The letter did not say why Medina was deemed ineligible.

Incarcerated New Yorkers applying for medical parole go through a lengthy process bookended by a medical evaluation at the outset and a final review by the parole board. How decisions are made at these two stages is opaque, but what’s in between is even more of a black box. Two officials within the prison agency—its chief medical officer, Morley, and its head, Acting Commissioner Anthony Annucci—reject many applications after they’ve passed their medical evaluations and before they’ve reached the board, typically with little explanation.

Their refusals have frustrated legal advocates, who question the murky criteria that prevent their clients from at least obtaining a board hearing where they can press their case. Annucci is already under heavy fire for conditions in New York prisons and the approximately 1,000 deaths that have occurred on his watch.

Medina is one of the people whose application got caught in this middle stage. Last November, he was diagnosed with glaucoma in his left eye, causing him pain and blurry vision, which makes moving around difficult. The CUNY legal team is currently gathering records for an independent medical review in preparation for a third medical parole request on his behalf.

Still locked up, afraid he will lose his eyesight completely, afraid he will never meet his daughter outside prison walls, Medina describes “the sad and painful reality of dying alone in a cold dark prison cell.”

“It is an unfortunate reality for all aging prisoners, especially those living with chronic medical conditions,” he told Bolts and New York Focus over email. “I only want to enjoy a moment at the beach with family, go to a movie theater, and experience a nice meal at an upscale restaurant before my departure.”

Most medical parole applications never make it to the parole board

Under New York law, the state parole board can grant medical parole to an incarcerated patient certified by the prison agency as suffering from a malady that renders them “so debilitated or incapacitated as to create a reasonable probability that he or she is physically or cognitively incapable of presenting any danger to society.”

In 2020, as Covid-19 exploded in the prison system, DOCCS received an enormous increase in medical parole requests—1,049 in total. It approved 18. 

In a statement to Bolts and New York Focus, a DOCCS spokesperson suggested that many of those applicants may not have been medically eligible. “As the law is currently written, concern that an individual with pre-existing conditions may contract COVID and be at an increased risk for a severe and possibly fatal outcome, is not a basis for medical parole,” the spokesperson said.

In 2021, the number of medical parole applications dropped dramatically, to 82. Of those, 10 people were released.

Applying for medical parole involves many steps. After an incarcerated person or someone on their behalf (such as a family member, attorney, or prison staff member) files an initial request, it must pass four distinct reviews: first by prison clinical staff, who conduct a medical evaluation; then by the DOCCS chief medical officer, who assesses the medical evaluation and the applicant’s risk to public safety; then by DOCCS acting commissioner Annucci; and finally, if the request has made it this far, by the state’s parole board.

If the application makes it to this final stage, the board holds a “medical parole hearing,” with an opportunity for the prosecutor, defense attorneys, sentencing court and the Office of Victim Assistance to provide input. From 2013 to 2017, records obtained by the Vera Institute of Justice show, the board granted medical parole about two-thirds of the time, well over its overall parole approval rate of 23 percent in 2015. 

But the vast majority of applications never make it that far.

According to Vera’s report, 476 requests for medical parole were filed between 2013 and 2017. Only 240 were approved by prison staff. Even then, only about half of the remaining pool made it to the parole board. Either the chief medical officer or the commissioner rejected many of those cases, though in some the applicant died while waiting, was released on another form of parole, or completed their sentence. 

Applications that are denied by the DOCCS leadership are typically issued form letters signed by the chief medical officer, currently Morley. (The chief medical officer is hired by DOCCS and supervised by its commissioner.) The letters give no reason for the denial—just that “it has been deemed that you are not an appropriate candidate for Medical Parole.” 

Zeidman shared a letter sent to one applicant that was originally addressed to another person. That name had been crossed out and his hand-written in. The man died three weeks later.

Last year, a state judge required Morley to explain why he denied the application of Wilfredo Lopez. Lopez had been diagnosed with amyloidosis, and a prison physician had identified the condition as terminal, giving him one to two years to live. 

Morley explained to the court why he didn’t consider that grounds for medical parole: “‘Terminal’ suggests a life expectancy of 6 months or less. Mr. Lopez is alive and continues to ambulate with a cane around Greene Correctional Facility.” 

Asked what factors go into Morley and Annucci’s decision to deny medical parole applications advanced by others, a DOCCS spokesperson referred New York Focus and Bolts to their directive, which mentions that the medical officer advises the commissioner about the applicant’s medical status. They also said the commissioner looks “to ensure that the law is being adhered to and that a medical parole release would not put public safety at risk.” Prison staff are directed only to conduct a medical evaluation, and not assess public safety, the spokesperson said. The parole board, to which Annucci forwards applications, is also meant to consider safety, though. The department declined to comment on the decision to deny Medina’s medical parole application, stating that it cannot comment on an individual’s health record.

Annucci has led DOCCS since 2013, when then-Governor Andrew Cuomo appointed him, but—even though the position is subject to legislative oversight—he has never been confirmed by the legislature. Governor Kathy Hochul nominated Annucci for the permanent position, but the acting commissioner is now facing significant resistance. Last month, the relatives of ten men who have died in prison issued a joint statement slamming Annucci for, among other things, “the regressive policies that he has promulgated, the scourge of racism and brutality he has sought to sweep under the rug.”

Sometimes, the prison agency’s delays mean that even the few who are granted release still die behind bars. In 2019, the parole board granted medical parole to 75-year-old Edgardo Carlos Gonzalez, who had served 36 years of a 50-to-life sentence. Gonzalez had liver failure, dropping from 175 to 112 pounds, and had been placed in the prison’s hospice ward.

Gonzalez never made it home. Instead, he remained in prison waiting for DOCCS to approve his placement in his family’s home. He was rushed to the hospital, diagnosed with end-stage cancer and—three months after filing a request for medical parole—died in custody. 

Dying in prison is the outcome Medina is desperate to avoid.

In August 2020, Medina thought that might happen after he contracted Covid. His condition was so severe that he needed breathing treatments at the infirmary. “I felt as if I was going to die during that devastating experience,” he said.

He recovered, but his health continued to decline. The following August, he was rushed to the hospital. “My heart beat was so fast, over 100, that when I got to the hospital they had no knowledge as to what was wrong with me,” he said. Medical staff found that he had a lung infection and a blood infection. He was given a series of steroids and IV treatments and remained hospitalized for three days. 

Last month, on March 24, Medina began experiencing stomach pains, nausea, and heart pains. He said  that a prison nurse took his blood pressure and found he had an alarmingly high systolic pressure of 224, which required immediate emergency medical care. He was sent to a hospital and given an IV, hypertension medications, and a CAT scan. Medical staff diagnosed him with prostate and urine infections and determined that he would need gallbladder surgery. Once his blood pressure dropped to 150/80, Medina was sent back to prison. 

The next day, he said, his systolic blood pressure again soared to 220, and he was sent to a different hospital. He was treated and, once his blood pressure dropped, returned to the prison. 

The following morning, his blood pressure yet again rose to 207. He was rushed to a third hospital, Albany Medical Center, where he spent four days. He spent a fifth night in the prison’s infirmary before returning to his housing unit. He is still experiencing nausea and discomfort in his abdomen.

“My one and last chance to know my father” 

Medina signs his emails “Tony the Fighter.” That refers to his numerous illnesses and near-brushes with death, not the fighting of his younger years. 

“I’ve spent my majority of my life trying to be a better man,” he told Bolts and New York Focus in one email. He recognizes that, as a 26-year-old in 1980, he was angry, prone to violence, and struggling with heroin addiction, a fatal combination that led him to set fire to the apartment he shared with his girlfriend and stepson. Both died in the fire. 

“Not a day goes by in 43 years where I don’t wish the events that took place did not take place and that Laura and Richard were here today living beautiful lives as God intended,” he wrote.

In prison, Medina taught himself to read and write in both English and Spanish. He converted to Christianity, which he describes as a major turning point in his life. He now spends his time creating art and mentoring younger men—which he plans to continue if he’s released. “Being able to enter society now with the lessons I’ve learned would allow me to help other youth from ending up in the same position,” he said.

Studies show that the risk that people released from prison will commit new crimes dramatically declines with age. In New York, just one percent of people released from prison over the age of 65 were sent back to prison on a new conviction, nine times lower than the overall rate. 

In 2019, Medina connected with his only daughter, Elizabeth, then 47, who had been born while Medina had been incarcerated a previous time. That October, she visited him in prison, the first time the two had ever met. “We ate and took pictures and when it was time to say goodbye, the tears began to rain from my eyes,” Medina recalled. The following day, Elizabeth visited again, this time bringing a food package. 

Now, Elizabeth says that she wants to care for her father during his final years.  “We never had time, me and my father,” she said in a video plea to Governor Hochul. “He’s very sick. I need every minute…. This is my one and last chance to get to know my father.”

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