Special Projects Fund

Grantee Name

Vera Institute of Justice

Funding Area

Special Projects Fund

Publication Date

December 2019

Grant Amount

$249,182

Grant Date:

November 2015 - April 2017

The number of individuals aging behind bars is growing at an alarming rate; experts estimate that by 2030, prisoners ages 55 and older will account for 30% of the correctional population.

On average, it costs approximately twice as much to incarcerate someone age 50 or older ($68,270) than a younger, more able-bodied individual ($34,135)—and in some cases, it may cost up to five times more. Aging prisoners also are more likely to have chronic medical issues or experience catastrophic medical events, resulting in substantial expenses for medical care. In New York State, medical parole can be granted to prisoners with terminal health conditions or significant and permanent nonterminal conditions or diseases. This population is so physically or cognitively debilitated or incapacitated that there is a reasonable probability they are no longer a danger to society; however, very few eligible prisoners are released through medical parole.

In 2015, NYSHealth awarded the Vera Institute of Justice a grant to form a planning project to assess medical parole implementation in New York State.

Outcomes and Lessons Learned

  • Assessed current New York State Department of Corrections and Community Supervision (DOCCS) policies and practices for medical parole and identified opportunities for improvements.
  • Analyzed a sample of 251 cases using detailed case-level data for medical parole requests between 2013 and 2015. Among the findings:
    • Only 12% of requests for medical parole made it as far as release.
    • 55% of initial medical parole requests and 44% of those approved were for incarcerated people ages 55 and older.
    • The six most common conditions for medical parole were: cancer; end-stage liver disease; cerebrovascular disease or accident; diabetes or other endocrine disorders; pulmonary conditions; and renal disease.
    • The New York State Board of Parole granted medical parole in 68% of cases, a higher rate than the overall parole grant rate of 25%.
    • Twice as many medical parole applicants die in custody than are released.
  • Developed and delivered training to more than 100 DOCCS Health Services staff and members of the parole board on the purpose and process of medical parole, as well as how to identify, prepare, and process applications for medical parole.
  • Conducted an online survey of 155 community care providers—including hospice care facilities, nursing homes, and home care providers—to understand the context around the services and barriers for treating someone who has serious medical needs on medical parole.
  • Surveyed facility clinicians, finding that 28% believed they were treating at least one eligible patient who had not yet been referred for medical parole. Clinicians identified time constraints and lack of administrative support as the primary barriers to referrals.
  • Published “A Question of Compassion: Medical Parole in New York State,” a report with specific recommendations and findings on the use of medical parole in New York State.
  • Identified specific non-legislative and legislative changes that could make the medical parole process more effective.
    • Non-legislative changes include:
      • Initiating new requests for medical parole at earlier stages in people’s illnesses;
      • Understanding and reducing the barriers to more medical parole requests through improved data collection capacity;
      • Improving communication between DOCCS and the parole board; and
      • Engaging families in the discharge planning process.
    • Legislative changes include:
      • Clarifying who should conduct the public safety/risk assessment;
      • Rethinking the role that notification of victims and law enforcement plays, including both the length of the comment period and the information provided to them; and
      • Prohibiting blanket exclusion policies for people with felony convictions in community health care settings.

Through this project, the Vera Institute found that clinicians often feel conflicted about their role in initiating medical parole requests and the burden of responsibility it imposed. Clinical staff reported a lack of clarity on how compassionate release fits into the department’s patient care mission; how to navigate the medical parole application process; and how critical a physician’s role is in early identification of potential applicants. As a result of this, many requests are made too late—24% of applicants in Vera Institute’s sample died while in custody. In 50% of these cases, the inmate’s death occurred less than two months after the process was initiated.

By the end of the grant, the Vera Institute had originally aimed to establish a pilot program to approve medical parole applications, which did not happen. It found that launching a pilot for DOCCS was too ambitious for the scope of this project. However, DOCCS was much more open to technical assistance and training for its clinical staff and the parole board about the purpose and process of medical parole, so the grant focused on delivering those trainings instead.

Co-Funding and Additional Funds Leveraged: N/A