Sometimes things in government just don’t make sense. When you look at the facts – the state pays nearly $43 million annually to guard and provide life-sustaining medical care for 32 critically debilitated state prison inmates – something seems out of whack. That’s an average of $1.3 million in costs per person.

Most of these inmates are completely incapacitated: incapable of independent movement or speech and with extremely limited cognitive function. The public safety threat posed by this small number of prisoners is virtually non-existent. Some of these extremely high-cost inmates are in a state corrections agency treatment bed, but most are already residing in a hospital setting beyond the prison walls. A recent editorial in the Fresno Bee argues that it is time to rethink these expenditures and consider a different way of handling these critically ill offenders.

A proposal to establish a medical parole program is now before the Legislature. That bill – SB 1399, by Senator Mark Leno – would create a process and criteria to allow the state to identify and put on medical parole – a new status in California, but a model already pursued in other states – inmates who are permanently debilitated and whose release would pose no public safety threat. Inmates sentenced to death, life without possibility of parole, or those sentenced under the Three-Strikes Law would be expressly excluded from the program. It is expected that approximately 700 state prison inmates would qualify for consideration for medical parole. SB 1399 is sponsored by the Federal Healthcare Receiver, who has jurisdiction over the state’s prison healthcare delivery system.

There are some who believe that people who are sentenced to prison should be obligated to serve out their term and pay a full debt to society, regardless of the cost or circumstances of their condition. That view is certainly legitimate. From the county perspective, we do not have a position on whether the state should pursue a medical parole model. But we do have a vested interest in how the state goes about designing this program. If these individuals are paroled from prison, their medical needs (and costs) will follow them. Counties are concerned about the manner, timing, and handoff associated with transitioning these inmates to a medical parole status.

Senator Leno has committed to ensuring that no new costs are shifted to counties or local health systems. As the bill evolves, we will be working with the author and sponsor to ensure that that the parole process fully considers and addresses all of the following: the development of a transition plan into the community, establishment of protocols for eligibility determination/application for public assistance programs, and vetting of a variety of legal and jurisdictional issues. This type of planning is especially critical in these cases, where the individual is likely unable to make medical decisions on his or her own. For example, if a family member or other representative is not available or willing to step forward, the public guardian would likely be called on – a potentially significant county cost for individual jurisdictions at a time when resources are becoming more and more scarce.

Regardless of where you stand on medical parole, the analysis of this policy reminds us yet again of the scope, reach and complexity of the county role. And it underscores the extent to which county programs, services, and fiscal health are intertwined with the many difficult policy and fiscal decisions before the Legislature. CSAC will keep counties apprised of discussions and developments on this important policy issue.

The California State Association of Counties is celebrating National County Government Month during the week of April 19 – 23, 2010. During the week, CSAC will be tweeting, blogging and posting Facebook information on county services, with a special daily focus. Monday – Agriculture and Natural Resources, Tuesday – Housing, Land Use and Transportation, Wednesday – Administration of Justice, Thursday – Health and Human Services, Friday – Government Operations.