SACRAMENTO — California has halted a court-ordered medical parole program, instead sending its most incapacitated inmates back to state prisons or releasing them early.
Attorneys representing prisoners and the author of the state’s medical parole legislation are protesting the unilateral termination, claiming it endangers this vulnerable population. The move is the latest twist in a long-running campaign to release those deemed so ill that they are no longer a threat to society.
“We have concerns that they cannot meet the needs of the population for things like memory care, dementia, and traumatic brain injury,” said Sara Norman, an attorney representing the prisoners in a federal class-action lawsuit filed nearly three decades ago. “These are not people who are in full command and control of their own surroundings, their memories — they’re helpless.”
Caring for the rapidly aging prison population is a growing issue in the United States. According to Johns Hopkins University researchers, imprisoning older people costs twice as much as imprisoning younger people, and prisoners aged 55 and up are more than twice as likely to have cognitive difficulties as non-incarcerated older adults.
According to the state parole board, medical parole is reserved for a small percentage of California’s 90,000 prisoners who have a “significant and permanent condition” that renders them “physically or cognitively debilitated or incapacitated” to the point where they cannot care for themselves.
Prisoners who qualify—those sentenced to death or life without parole are excluded—can be housed in a community health care facility rather than a state prison.
Attorneys said the roughly 20 parolees the state has returned to prison require significant assistance with basic daily functions, with some in wheelchairs or suffering from debilitating mental or physical disabilities. They claim that outside facilities have the ability to provide more compassionate and humane care to severely ill prisoners.
Kyle Buis, a spokesperson for California Correctional Health Care Services, described the program as “on pause” as patients return to in-prison facilities and officials anticipate increasing the use of the compassionate release program. Prisoners granted compassionate release have their sentences reduced and are released back into society, whereas those on medical parole remain technically in custody.
“There were multiple considerations that went into this decision,” Buis told reporters. “Our growing ability to support those with cognitive impairment inside of our facilities was one factor.” Governor Gavin Newsom also mentioned “eliminating non-essential activities and contracts” to save money.
According to the National Conference of State Legislatures, medical parole laws are now in place in almost every state, but they are rarely used. One common reason is eligibility. Texas, for example, screened over 2,600 inmates in 2022 but only approved 58.
According to the Vera Institute of Justice, a national nonprofit research and advocacy organization, officials frequently face procedural hurdles as well.
Some states have attempted to expand medical parole programs. Michigan did so because an earlier version of the law proved too difficult to apply, resulting in the release of only one individual. New York has some of the most broad release criteria in the country, but it is one of the states that is having difficulty finding nursing home placements for parolees.
California’s first attempt to free prisoners deemed so incapacitated that they are no longer dangerous began in 1997 with a rarely used procedure that allowed corrections officials to request the release of dying prisoners. However, that program resulted in the release of only two prisoners in 2009.
The medical parole program was established by a state law that went into effect in 2011 and was expanded in 2014 to help reduce prison crowding, which was so severe that federal judges ruled it was endangering prisoners’ physical and mental health.
State officials reported that nearly 300 prisoners have been granted medical parole since July 2014. Buis estimated that the average annual cost per medical parolee would range between $250,000 and $300,000 in 2023.
And, despite lawmakers’ expectations when they launched the program, he claims Medi-Cal — California’s Medicaid program, which is partially funded by the federal government — did not reimburse the state for their care because they were still considered incarcerated.
California has had a turbulent relationship with its sole nursing home contractor for medical parolees. According to Newsom’s January summary of the state’s 2025-26 budget, the state will end its contract with Golden Legacy Care Center in Sylmar (Los Angeles County) at the end of 2024.
In 2021, prison officials announced that they were returning dozens of paralyzed and otherwise disabled prisoners to state prisons and limiting medical parole, citing a federal rule change that prohibited restrictions on prisoners in such facilities.
Golden Legacy was fined by state public health inspectors for handcuffing an incapacitated patient’s ankle to the bed, which violated both state and federal laws.
Golden Legacy did not respond to repeated telephone and email requests for comment. Buis claimed that state employees “continuously monitored care at Golden Legacy, and we never had concern for the quality of care provided.”
Attorney Rana Anabtawi, who also represents prisoners in the class-action suit, accompanied Norman on a tour of Golden Legacy’s medical parole building in November, where she observed caregivers offering memory care patients special art classes and a “happy feet” dance party.
The facility she visited “was a much better place for our patients than being in prison — there appeared to be regular programming aimed at engaging them, there were no officers walking around, the patient doors were open and unlocked, patients had general freedom of movement within their building.”
Over the last few years, the California Department of Corrections and Rehabilitation has increased its capacity to serve those in critical condition.
The state established two memory care units in men’s prisons: a 30-bed unit in the California Health Care Facility in Stockton in 2019, and a 35-bed unit in the California Medical Facility in Vacaville in 2023.
The Central California Women’s Facility in Chowchilla (Madera County) offers up to 24-hour skilled nursing care to women with life-threatening illnesses, including dementia.
Norman, however, is concerned that in-prison facilities are inadequate.
“They’re nowhere near enough and they are inside prisons, so there’s a limit to how compassionate and humane they can be,” she informed us.
In addition to the 20 who were returned to state prisons when the contract expired, Buis stated that one was paroled using the standard process, and 36 were recommended for compassionate release. Of those, 26 received compassionate release, eight were denied, and two died before being considered.
The use of compassionate release increased after a law was passed in 2022 that relaxed the criteria, including the addition of dementia patients. Last year, 87 prisoners were granted compassionate release.
In contrast, during the six years preceding the new law, only 53 people were released. According to Buis, officials anticipate that approximately 100 prisoners will be eligible for compassionate release each year.
Compassionate release would allow them to “sort of die with dignity,” said Daniel Landsman, vice president of policy for the criminal justice advocacy group FAMM, formerly known as Families Against Mandatory Minimums, and ensure “that the California prison system is not turning into a de facto hospice or skilled nursing facility.”
Mark Leno, a Democratic state senator who authored California’s medical parole law, chastised prison officials for abandoning the law without legislative approval and simply terminating the Golden Legacy contract. He also railed against returning severely ill patients to prison, calling the decision “perfectly inhumane.”
“Is it just cruel punishment and retribution, or is this thoughtful execution of the law put in place by the legislature?” he said.
