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Hello everyone. I'm Joanne Faryon.

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Welcome to this Envision special

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Life In Prison

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About one in five of all inmates in California are serving life sentences.

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Combined, they could potentially cost taxpayers in this state $140 billion

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over the course of their sentences.

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Lifers are getting more expensive because they're aging in prison and rarely paroled.

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It's all adding up to record health care costs for inmates.

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Tonight, we explore the cost of California's tough on crime legislation.

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It's lead to so much overcrowding in state prisons the federal courts have stepped in.

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You'll meet some lifers - men who were sent to prison

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when Lyndon B. Johnson was president and they're still there.

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This is not a report on whether they should be paroled - it is an examination

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of how much it costs to lock people up and rarely let them out.

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Especially when locking them up means you're responsible for their healthcare.

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At first glance this could look like a nursing home.

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The wheelchairs and walkers have a way of fooling you.

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This is the California Medical Facility, one of California's 33 prisons.

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CMF operates the largest prison hospital.

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It's where many of the states old, sick and dying inmates will end up.

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And these days, those old and sick inmates are growing in number.

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California faces a problem that touches nearly every aspect of society -

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from our economy to our safety to our health - one that forces us to take sides

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between punishment and redemption.

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We've too many men and women in our prisons.

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The statistics say so, and so did a federal court in 2002.

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There are 170,000 inmates in prisons that were built for 100,000.

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One in five serving life sentences.

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TERRY CAMPBELL (Inmate): My name is Terry Campbell.

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I'm in prison for murder, first-degree murder, and I've been in prison for 44 years.

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GLENDA VIRGIL (Inmate): "My name is Glenda Virgil, and I'm serving a 15-to-life sentence.

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I've been here 23 years.

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--And how old are you?

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And I'm 63 years old.

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RICHARD LAURENZANO (Inmate): Being 62 in prison is a struggle, it's a struggle.

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--Why?

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Well, first of all the reflection of losing 27 years of your life but you get sicker.

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--Richard Lauranzano represents the fastest growing segment

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of the inmate population: men over 50.

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He's also among the most expensive.

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He's been sick and has been treated at hospitals outside the prison system.

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LAURENZANO: I had cancer about four years ago, stage 4.

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The prison system saved my life.

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They sent me out to outside hospitals they never hesitated.

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--Glenda Virgil has had surgery.

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VIRGIL: I've had major back surgery.

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I was in the hospital with two guards 24 hours a day for 11 days.

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Now, I can't imagine what that cost.

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But that just for the guards alone I would imagine that was over $200,000.

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you know because that 2 guards - because I'm a lifer - 2 guards for 24 hours everyday.

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--Terry Campbell has had seven operations.

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CAMPBELL: My back.

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My shoulders because I broke bones in both my back and shoulders.

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My hand, twice.

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CLARK KELSO: We're dealing with a corrections population that is aging in prison.

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--Clark Kelso is in charge of health care in California's prisons.

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So we've seen explosion in Cardiovascular problems, and we've got a lot of Diabetes,

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we have the results of Hepatitis C, there was sort of an epidemic of it, an exposure in the 80's,

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we began to see the results of that now.

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We have a lot of inmates who have very serious liver disease

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as the result of an abuse of drugs and alcohol.

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But they're all at the age now where you have those issues plus other chronic conditions

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that simply require a different type of care.

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--A federal judge made Kelso a receiver

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and put him in charge when a court ruled inmates did not have access to health care

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and mental health services because California's prisons were so over crowded.

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The court ruled lack of health care was cruel and unusual punishment

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and violated inmates' constitutional rights.

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A panel of federal judges has since ordered California to come up with a plan

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to reduce its prison population by 40,000 inmates.

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Both decisions forced the state to confront its overcrowding problem and challenged the public

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to contemplate the health care debate in a whole new way.

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If we as a country can't decide whether health care is a right for all free citizens -

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why is it so easily determined as a right for convicted criminals?

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It's a question Clark Kelso has been asked many times.

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KELSO: The technical legal answer is there's a huge difference

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between government's responsibility to you a citizen, a free citizen,

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and government's responsibility to someone that government is incarcerating.

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Once you have incarcerated someone, government has a constitutional obligation

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under the Eighth Amendment to provide certain levels of care

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and that what the state has to do.

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--Since the receivership assumed control of health care

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in prisons three years ago, spending on medical treatment for inmates has almost doubled -

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from just over one billion dollars a year to nearly two billion dollars.

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And that budget will increase if the state is to continue providing health care

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to its growing geriatric population.

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One independent report projects the number of men

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in California prisons over age 60 will triple by 2018.

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KELSO: The state of California and the people of California have made consistent judgments

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that certain types of crimes or certain patterns of criminal conduct need to be punished

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with life in prison and that's a judgment that has to be respected. I think from my perspective

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what the State needs to realize is, that those decisions come with a cost.

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That you can't have a prison population 16, 20 per cent of which in a maybe a decade or two

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are going to be 55 and older. You can't do that unless you're willing

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to devote a very substantial portion of the general fund to their health care

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because those aging prisoners are going

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to have health care needs that are very expensive to meet.

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--There are about 35,000 lifers in California prisons.

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Using government statistics, KPBS calculated how much money the state pays

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to imprison inmates for a life sentence.

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If Inmate X is incarcerated at age 37, he costs taxpayers about $49,000 a year.

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But as he ages, his health care expenses will increase.

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At age 55, he could cost the state $150,000 a year.

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If he lives until he's 77, he will cost California taxpayers

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as much $4 million to keep him in prison for life.

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FARYON: So, when you were first convicted and sent to prison, did you expect to still be

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in prison when you were sixty-five?

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CAMPBELL: No, not at all.

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No, I believed the hype that if you change while you're in prison and prove to us

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that you're capable of functioning in society by doing the programs that we provide,

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showing us that you've rehabilitated and the staff supports

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that effort then, CDC staff supports that effort, then you will be paroled.

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--Lifers rarely get parole.

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In 2008, 7,303 lifers were up for parole.

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The board granted 294.

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But the Governor has the right to reverse those decisions or send them back for review.

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In 2008, Governor Arnold Schwarzenegger denied 81 lifers parole

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and sent more than 30 cases back for review.

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Fewer than 60 inmates were released.

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The year before even fewer were paroled and in 2006, fewer still.

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--To understand why Californians developed this 'tough on crime' mantra,

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you have to go back to the days of Charles Manson.

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At the time, homicide rates were on the rise -

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nearly doubling from the mid-sixties to the late 70's.

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HARRIET SALARNO: Because the high crime,

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murder was on the rampage and the people were getting furious.

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FARYON: Harriet Salarno was raising a family in San Francisco at the time.

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She and her husband owned an electronics store.

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They kept a gun because stores like theirs were often the target of robberies.

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It was the gun her daughter's killer would use in 1979.

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SALARNO: And he shot her and murdered her execution style.

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And he went up to his dorm didn't call any help or anything watched her try to call and she died

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and finally another student found her and it was too late.

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FARYON: When Salarno learned her daughter's killer was up for parole

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after just serving 10 years, she began a life-long campaign

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for tougher sentencing laws and stricter parole policies.

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Her victims rights group raises enough money to employ a full-time lobbyist in Sacramento.

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SALARNO: Public safety is in our constitution

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and it's the priority and it must be served first.

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So, we will back right there lobbying as heavy

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as we can every morning we'll have a new case that we will be able to discuss with whatever legislator we meet that day

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because somebody was murdered. It will be on the morning news as it is every morning.

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And we'll be back there. And that's their obligation.

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Their obligation as legislators is to do this.

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FARYON: Dozens of changes to sentencing laws in the last few decades have all contributed

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to California's highest rate of lifers in prison.

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Two of the most significant, are determinate sentencing in 1977,

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which imposed minimum sentences, and three strikes in 1994,

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which allowed repeat offenders to be sentenced to life.

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LINDA: My sentence is 15 to life.

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FARYON: And you've been here how long?

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LINDA: I'm in my 24th year.

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FARYON: And Glenda?

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VIRGIL: Fifteen to life, plus two for a gun allocation.

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And I've been here for 23 years.

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FARYON: And Marylinn?

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MARYLINN: Mine is 15 to life for second-degree murder and I've been down 25.

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FARYON: At the California Institution for Women in Corona California, a group of inmates,

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all convicted murderers, all women, talk about what its like to grow old in prison.

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LINDA: The change is for me my health.

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My health has declined and the getting around that I don't have anymore.

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I didn't think that I would ever grow old.

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That my hips wouldn't work, that I couldn't get down or get up anymore, or my legs.

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MARYLINN: And never in my life did I think I'd be sitting in prison and going,

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"Wow, I'm 70 years old and I don't even have a retirement plan."

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I don't have to go to work everyday because that's the program.

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That's what you have to do.

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Or that I would have lost my whole family behind these circumstances.

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That I would no longer have a family to reach out to.

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FARYON: The women are part of a group called the Golden Girls,

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inmates over 55 who are granted special privileges

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like a double mattress on their metal cots.

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And they're first in line during meals.

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But this is still prison.

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And there are rules.

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Like getting down on the floor when an alarm sounds.

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This happened while we were there.

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59-year-old Linda Vivian can barely make it down or back up again.

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DR. JOSEPH BICK: Prisons weren't built to make it easy

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for mobility-impaired people to get around.

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Prisons were built to safely incarcerate individuals who are sent away

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and keep them from escaping.

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So we're trying to deal with things about how do you accommodate activities of daily living

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of somebody who's in their 60s, 70s, and 80s.

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Simple things like getting their clothes on, using the bathroom,

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ambulating down the hallway to the dining halls.

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Having enough time to eat.

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Having more than 15 minutes to consume a meal.

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FARYON: Dr. Joseph Bick has been working as a prison doctor for 20 years.

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He tends to patients at CMF's hospital and the prison hospice,

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where he's held the hand of many dying inmates.

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DR. JOSEPH BICK: I'm not privy to inmates' commitment offenses as a clinician,

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it's something I'm not particularly interested in knowing.

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In fact I endeavour to not know because I think my job is

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to provide the best quality of health care I can.

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But I'm human too and I don't want to run the risk of being influenced

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by knowledge of someone's commitment offense.

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FARYON: We met two inmates in the prison hospice on the day of our visit.

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Angelo Chavez has end-stage liver disease.

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ANGELO CHAVEZ: I was hoping they would give me a compassionate release

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and that's what I'm waiting for, to see if I can go home to my family.

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FARYON: Chavez is a three striker and serving a life sentence.

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His convictions include drug possession, robbery and manslaughter.

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CHAVEZ: I would love to go home and die out there, than to die here.

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FARYON: We also met Brian Long.

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He has cancer and is expected to live another three months.

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In 1993, Long was convicted of having sex with a minor and served six years.

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In 2003 he was sentenced to 11 years for a second sexual offense against a child.

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In California, inmates can be released for compassionate reasons

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if they have less than six months to live.

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Last year there were 57 requests.

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Three were granted by the courts.

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DR. JOSEPH BICK: People have very strong opinions on all sides

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of this discussion you certainly have people who have been victims or their family members

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of some very heinous crimes from some of the people who live in this facility.

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And they strongly feel that it doesn't matter how old somebody gets or how sick they get

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or what they're likelihood of reoffending is they should spend the rest

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of their life in prison.

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FARYON: But Dr. Bick says we can't deny them health care.

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Not only is it the law, it is also a matter of public health.

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DR. JOSEPH BICK: With so many people incarcerated we choose as a society

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to incarcerate people that come to us with such an incredible burden of disease,

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HIV and hepatitis and tuberculosis and mental illness

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and substance abuse whoa re someday going to go home, to me the tragedy is

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to somehow ignore them an put them off there and assume

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because they're incarcerated they don't matter or they're not going

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to somehow impact upon the general health at time of release.

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FARYON: And how do you see your life playing out then here as you age?

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CAMPBELL: I'll just grow old and eventually I'll die.

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I don't see it as - you know I'm well adapted.

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Institutionalized, if you will.

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So I don't see a problem just existing.

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Eventually I wont be able to function anymore and eventually I'll end

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up in a hospital and eventually I'll die.

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But in the meantime it's going to cost the state an awful lot of money to take care of me.

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FARYON: Terry Campbell was convicted in 1966 of murder during an armed robbery.

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He has two other convictions from 1968 and 1973, both while incarcerated.

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He told KPBS he was mixed up with prison gang violence.

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Since that time Campbell has earned two college degrees FARYON:

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What's your biggest fear about growing old in prison?

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CAMPBELL: I don't know if it's a fear, but my biggest concern about growing old in prison is

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that I went through all the trouble - on a personal level I went through all the trouble

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to change, to become a different person and now I don't know

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for what reason other than personal satisfaction.

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I can't give anything back.

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VIRGIL: And being alone.

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Dying alone where there isn't anyone who cares about you or knows you.

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FARYON: Glenda Virgil was convicted of second-degree murder in 1987 for shooting

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and killing the man with whom she had been involved.

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She told KPBS she had been a battered woman.

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LAURANZANO: They didn't give you life without,

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they didn't give you the death penalty they gave you 25 to life or 15 to life

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that means you get out at some point.

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And if you do everything they say you should get out and be a functioning member of society.

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FARYON: Richard Lauranzano was convicted of seven counts

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of sexual assault with children under 14 in 1984.

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While in prison he was also convicted of murder in connection.

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He is serving a 50-year sentence but is eligible for parole in 2013.

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Lauranzano's cancer is in remission, but he has heart trouble

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and is consulting with experts about surgery.

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GOVERNOR: 30 years ago 10% of the general fund went

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to higher education and only 3% went to prisons.

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Today almost 11% goes to prisons and only 7.5% goes to higher education.

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Spending 45% more on prisons than universities is no way to proceed into the future.

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FARYON: But it will be a difficult ship to turn given California's 30-year history of support

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for longer prison sentences and this administration's record of denying parole.

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Plans to build a new billion-dollar prison to house old inmates who need chronic care

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and inmates who need mental health services are now underway.

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There isn't room for them anywhere else.

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Clark Kelso is also looking at ways to get his outside hospital costs down.

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Last year the state spent 500 million dollars on those visits - about 1,000 very sick

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and dying inmates accounted for most of that cost.

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KELSO: There are solutions I think the legislature

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and the people need o become more comfortable with such as medical parole or other types

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of programs that will get these unhealthy inmates these again inmates

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who don't pose very much threat to the public in terms of recidivism very good numbers there,

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we have to come to a better public understanding in California

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with how to take care of those inmates.

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FARYON: Kelso has been in talks with officials, including the governor's office,

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about releasing some inmates to privately run secure nursing homes.

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According to government statistics, people over 55 have less

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than a four per cent recidivism rate which means they are the least likely of all inmates

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to commit another offense and return to prison.

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And once released from state run prisons, it's likely they'd be eligible

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for federal health care subsidies.

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KELSO: One way or another health care needs

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of these people are going to be paid for by somebody.

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FARYON: Should a life sentence mean a life sentence in California?

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If they're not rehabilitated absolutely.

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HARRIET: What are you going to do with them if you let them out?

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Where are they going to go?

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What are you going to do with them?

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You're going to say they're not going to commit a crime if they can't get a job

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and you're talking maybe 65 they need to make some income and they cant get a job

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and they have no place to live what are they going to do they're going

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to rob somebody's home, where are they going to get the money.

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You just don't open the door here's your $200 go get the bus.

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FARYON: Do you ever think you will get out?

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CAMPBELL: No.

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No I don't.

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That saying about it doesn't really matter where you are, but it always matters who you are?

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You know, that applies.

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That applies to a lot of us that are in prison because there are a lot of lifers who came

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to prison, who didn't get into trouble like I got into trouble

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when I came to prison, who are still here.

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And they're sitting around wondering, well what do I have to do?

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What do I have to do to get out of prison?

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How do I prove myself and who do I prove myself to?

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And there's no answer.

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FARYON: You can learn more about this issue by going to our website, kpbs.org/prisons.

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And you can also leave us a comment.

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We'd love to hear from you.

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For KPBS, I'm Joanne Faryon, thanks for watching.