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JOANNE FARYON (Host): Hello everyone.

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Welcome to this Envisionspecial, "Life in Prison."

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

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Combined, they could potentially costtaxpayers in this state $140 billion

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over the course of their sentences.

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

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

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

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It's lead to so much overcrowding in stateprisons 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 waspresident and they're still there.

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

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

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

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At first glance this couldlook like a nursing home.

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The wheelchairs and walkershave a way of fooling you.

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

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CMF operates the largest prison hospital.

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

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

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California faces a problem that touchesnearly every aspect of society -

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

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between punishment and redemption.

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We have too many men and women in our prisons.

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The statistics say so and sodid a federal court in 2002.

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There are 170,000 inmates inprisons 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-degreemurder, and I've been in prison for 44 years.

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

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I've been here 23 years.

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FARYON: And how old are you?

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VIRGIL: And I'm 63 years old.

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

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First of all the reflection of losing 27years of your life but you get sicker.

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FARYON: Richard Lauranzanorepresents 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 athospitals outside the prison system.

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LAURENZANO: I had cancerabout four years ago, stage 4.

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The prison system saved my life.

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They sent me to outside hospitals they neverhesitated FARYON: 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 guards24 hours a day for 11 days FARYON:

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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 bonesin both my back and shoulders.

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My hand, twice.

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

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. FARYON: Clark Kelso is in charge ofhealth care in California's prisons.

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KELSO: So we've seen explosion in cardiovascularproblems, an explosion in diabetes,

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we have the results of hep c, there wassort of an explosion of it in the 80;

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s we're seeing the results of that now.

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We have a lot of inmates whohave very serious liver disease

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because of an abuse of drugs and alcohol.

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

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which simply require a different type of care"FARYON: A federal judge made Kelso a receiver

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

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

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The court ruled lack of health carewas cruel and unusual punishment

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and violated inmates' constitutional rights.

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

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to reduce its prison populationby 40,000 inmates.

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Both decisions forced the state to confront itsovercrowding problem and challenged the public

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to contemplate the health caredebate in a whole new way.

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

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why is it so easily determined asa right for convicted criminals?

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It's a question Clark Kelsohas been asked many times.

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KELSO: The technical legal answeris there's a huge difference

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between government's responsibilityto you a citizen, a free citizen,

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and government's responsibility tosomeone that government is incarcerating.

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Once you have incarcerated someone,government has a constitutional obligation

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under the 8th amendment toprovide certain levels of acre

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and that what the state has to do.

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FARYON: Since the receivershipassumed control of health care

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in prisons three years ago spending on medicaltreatment for inmates has almost doubled -

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from just over one billion dollars ayear to nearly two billion dollars.

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

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to its growing geriatric population.

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One independent report projectsthe number of men

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in California prisons overage 60 will triple by 2018.

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

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

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with life in prison and that's a judgment thathas to be respected from my perspective is

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that needs to realize thosedecisions come with a cost

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

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or to 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 ofthe 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 thatare very expensive to meet.

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FARYON: There are about 35,000lifers in California prisons.

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Using government statistics, KPBScalculated 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 healthcare expenses will increase.

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

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

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as much $4 million to keephim in prison for life.

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FARYON: So, when you were first convictedand 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 changewhile you're in prison and prove to us

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

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showing us that you've rehabilitatedand the CDC staff supports

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that effort, then you will be paroled.

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FARYON: Lifers rarely get parole.

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In 2008, the most recentyear statistics are available

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for the full 12months, 7,303lifers were up for parole.

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The board granted 294.

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But the governor has the right to reversethose decisions or send them back for review.

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In 2008 Governor Arnold Schwarzeneggerdenied 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 wereparoled and in 2006, fewer still.

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MANSON MURDERS NEWS CLIP:In a scene...found dead.

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FARYON: To understand why Californiansdeveloped this tough on crime mantra,

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you have to go back to thedays of Charles Manson.

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At the time homicide rates were on the rise -

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nearly doubling from the midsixties to the late 70's.

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HARRIET SALARNO: Because the high crime,

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murder was on the rampage andpeople were getting furious.

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FARYON: Harriet Salarno was raising afamily 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 liketheirs were often the target of robberies.

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

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SALARNO: And he shot her andmurdered her execution style.

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

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and finally another studentfound her and it was too late.

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FARYON: When Salarno learned herdaughter'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 lawsand stricter parole policies.

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Her victims rights group raises enough moneyto 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 andit must be served first.

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We will back right there lobbying as heavy

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as we can every morning we will have a new casewe will be able to discuss with a legislator

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because somebody was murdered it will beon the morning news as it is every morning.

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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 lawsin the last few decades have all contributed

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to California's highest rateof lifers in prison.

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Two of the most significant, aredeterminate sentencing in 1977,

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which imposed minimum sentences,and three strikes in 1994,

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which allowed repeat offendersto 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, plustwo 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 forsecond-degree murder and I've been down 25.

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

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all convicted murderers, all women, talkabout 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 gettingaround that I don't have anymore.

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

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

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

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wow I'm 70 years old and I don'teven have a retirement plan.

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I don't have to go to workeveryday 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 wholefamily behind these circumstances.

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That I would no longer havea family to reach out to.

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

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inmates over 55 who are grantedspecial 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 thefloor when an alarm sounds.

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This happened while we were there.

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59-year-old Linda can barelymake it down or back up again.

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DR. JOSEPH BICK: Prisonsweren'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 safelyincarcerate individuals whoa re sent away

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and keep them from escaping.

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So we're trying to deal with things how doyou 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 theirclothes on, going to 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 beenworking as a prison doctor for 20 years.

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He tends to patients at CMF'shospital 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 particularlyinterested in knowing.

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In fact I endeavour to notknow because I think my job is

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to provide the best qualityof health care I can.

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But I'm human too and I don't wantto 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 theprison 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 theywould give me a compassionate release

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

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FARYON: Chavez is a three strikerand serving a life sentence.

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His convictions include drugpossession, robbery and manslaughter.

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CHAVEZ: I would love to go home anddie 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 expectedto live another three months.

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

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

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In California, inmates can bereleased 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 havevery strong opinions on all sides

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

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

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

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or what they're likelihood ofreoffending is they should spend the rest

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of their life in prison.

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

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

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

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

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HIV and hepatitis and tuberculosisand mental illness

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

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to somehow ignore them anput them off there and assume

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

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to somehow impact upon thegeneral health at time of release.

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

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CAMPBELL: I'll just growold 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 functionanymore 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 thestate an awful lot of money to take care of me.

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FARYON: Terry Campbell was convicted in1966 of murder during an armed robbery.

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

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He told KPBS he was mixed upwith prison gang violence.

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Since that time Campbell hasearned two college degrees FARYON:

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What's your biggest fearabout growing old in prison?

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

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that I went through all the trouble - on apersonal level I went through all the trouble

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

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for what reason other thanpersonal 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 anyonewho cares about you or knows you.

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

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and killing the man withwhom 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 penaltythey 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 shouldget out and be a functioning member of society.

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FARYON: Richard Lauranzanowas convicted of seven counts

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of sexual assault with childrenunder 14 in 1984.

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While in prison he was alsoconvicted of murder in connection.

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

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Lauranzano's cancer is inremission, 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 andonly 7.5% goes to higher education.

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

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

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

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

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and inmates who need mentalhealth 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 toget his outside hospital costs down.

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

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and dying inmates accountedfor most of that cost.

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KELSO: There are solutionsI think the legislature

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

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of programs that will get theseunhealthy inmates these again inmates

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

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we have to come to a betterpublic 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 withofficials, including the governor's office,

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about releasing some inmates toprivately 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 whichmeans 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 runprisons, 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 goingto be paid for by somebody.

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

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If they're not rehabilitated absolutely.

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HARRIET: What are you going todo 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 tocommit a crime if they can't get a job

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

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and they have no place to live whatare they going to do they're going

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

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You just don't open the doorhere'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 whereyou 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 prisonbecause there are a lot of lifers who came

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to prison, who didn't get intotrouble 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 aroundwondering, 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 andwho 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 issueby going to our website, kpbs.org/prisons.

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And you can also leave 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.