JOANNE FARYON (Host): Hello everyone.

Welcome to this Envisionspecial, "Life in Prison."

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

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

over the course of their sentences.

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

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

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

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

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

when Lyndon B. Johnson waspresident and they're still there.

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

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

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

At first glance this couldlook like a nursing home.

The wheelchairs and walkershave a way of fooling you.

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

CMF operates the largest prison hospital.

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

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

California faces a problem that touchesnearly every aspect of society -

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

between punishment and redemption.

We have too many men and women in our prisons.

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

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

One in five serving life sentences.

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

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

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

I've been here 23 years.

FARYON: And how old are you?

VIRGIL: And I'm 63 years old.

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

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

FARYON: Richard Lauranzanorepresents the fastest growing segment

of the inmate population: men over 50.

He's also among the most expensive.

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

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

The prison system saved my life.

They sent me to outside hospitals they neverhesitated FARYON: Glenda Virgil has had surgery.

VIRGIL: I've had major back surgery.

I was in the hospital with two guards24 hours a day for 11 days FARYON:

Terry Campbell has had seven operations.

CAMPBELL: My back.

My shoulders because I broke bonesin both my back and shoulders.

My hand, twice.

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

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

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

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

s we're seeing the results of that now.

We have a lot of inmates whohave very serious liver disease

because of an abuse of drugs and alcohol.

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

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

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

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

The court ruled lack of health carewas cruel and unusual punishment

and violated inmates' constitutional rights.

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

to reduce its prison populationby 40,000 inmates.

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

to contemplate the health caredebate in a whole new way.

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

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

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

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

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

and government's responsibility tosomeone that government is incarcerating.

Once you have incarcerated someone,government has a constitutional obligation

under the 8th amendment toprovide certain levels of acre

and that what the state has to do.

FARYON: Since the receivershipassumed control of health care

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

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

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

to its growing geriatric population.

One independent report projectsthe number of men

in California prisons overage 60 will triple by 2018.

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

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

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

that needs to realize thosedecisions come with a cost

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

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

to devote a very substantial portion ofthe general fund to their health care

because those aging prisoners are going

to have health care needs thatare very expensive to meet.

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

Using government statistics, KPBScalculated how much money the state pays

to imprison inmates for a life sentence.

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

But as he ages, his healthcare expenses will increase.

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

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

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

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

in prison when you were sixty-five?

CAMPBELL: No, not at all.

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

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

showing us that you've rehabilitatedand the CDC staff supports

that effort, then you will be paroled.

FARYON: Lifers rarely get parole.

In 2008, the most recentyear statistics are available

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

The board granted 294.

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

In 2008 Governor Arnold Schwarzeneggerdenied 81 lifers parole

and sent more than 30 cases back for review.

Fewer than 60 inmates were released.

The year before even fewer wereparoled and in 2006, fewer still.

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

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

you have to go back to thedays of Charles Manson.

At the time homicide rates were on the rise -

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

HARRIET SALARNO: Because the high crime,

murder was on the rampage andpeople were getting furious.

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

She and her husband owned an electronics store.

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

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

SALARNO: And he shot her andmurdered her execution style.

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

and finally another studentfound her and it was too late.

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

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

for tougher sentencing lawsand stricter parole policies.

Her victims rights group raises enough moneyto employ a full time lobbyist in Sacramento.

SALARNO: Public safety is in our constitution

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

We will back right there lobbying as heavy

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

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

And that's their obligation.

Their obligation as legislators is to do this.

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

to California's highest rateof lifers in prison.

Two of the most significant, aredeterminate sentencing in 1977,

which imposed minimum sentences,and three strikes in 1994,

which allowed repeat offendersto be sentenced to life.

LINDA: My sentence is 15 to life.

FARYON: And you've been here how long?

LINDA: I'm in my 24th year.

FARYON: And Glenda?

VIRGIL: Fifteen to life, plustwo for a gun allocation.

And I've been here for 23 years.

FARYON: And Marylinn?

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

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

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

LINDA: The change is for me my health.

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

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

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

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

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

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

That's what you have to do.

Or that I would have lost my wholefamily behind these circumstances.

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

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

inmates over 55 who are grantedspecial privileges

like a double mattress on their metal cots.

And they're first in line during meals.

But this is still prison.

And there are rules.

Like getting down on thefloor when an alarm sounds.

This happened while we were there.

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

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

for mobility-impaired people to get around.

Prisons were built to safelyincarcerate individuals whoa re sent away

and keep them from escaping.

So we're trying to deal with things how doyou accommodate activities of daily living

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

Simple things like getting theirclothes on, going to the bathroom,

ambulating down the hallway to the dining halls.

Having enough time to eat.

Having more than 15 minutes to consume a meal.

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

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

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

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

it's something I'm not particularlyinterested in knowing.

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

to provide the best qualityof health care I can.

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

by knowledge of someone's commitment offense.

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

Angelo Chavez has end-stage liver disease.

ANGELO CHAVEZ: I was hoping theywould give me a compassionate release

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

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

His convictions include drugpossession, robbery and manslaughter.

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

FARYON: We also met Brian Long.

He has cancer and is expectedto live another three months.

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

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

In California, inmates can bereleased for compassionate reasons

if they have less than six months to live.

Last year there were 57 requests.

Three were granted by the courts.

DR. JOSEPH BICK: People havevery strong opinions on all sides

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

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

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

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

of their life in prison.

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

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

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

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

HIV and hepatitis and tuberculosisand mental illness

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

to somehow ignore them anput them off there and assume

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

to somehow impact upon thegeneral health at time of release.

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

CAMPBELL: I'll just growold and eventually I'll die.

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

Institutionalized, if you will.

So I don't see a problem just existing.

Eventually I wont be able to functionanymore and eventually I'll end

up in a hospital and eventually I'll die.

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

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

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

He told KPBS he was mixed upwith prison gang violence.

Since that time Campbell hasearned two college degrees FARYON:

What's your biggest fearabout growing old in prison?

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

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

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

for what reason other thanpersonal satisfaction.

I can't give anything back.

VIRGIL: And being alone.

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

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

and killing the man withwhom she had been involved.

She told KPBS she had been a battered woman.

LAURANZANO: They didn't give you life without,

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

that means you get out at some point.

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

FARYON: Richard Lauranzanowas convicted of seven counts

of sexual assault with childrenunder 14 in 1984.

While in prison he was alsoconvicted of murder in connection.

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

Lauranzano's cancer is inremission, but he has heart trouble

and is consulting with experts about surgery.

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

to higher education and only 3% went to prisons.

Today almost 11% goes to prisons andonly 7.5% goes to higher education.

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

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

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

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

and inmates who need mentalhealth services are now underway.

There isn't room for them anywhere else.

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

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

and dying inmates accountedfor most of that cost.

KELSO: There are solutionsI think the legislature

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

of programs that will get theseunhealthy inmates these again inmates

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

we have to come to a betterpublic understanding in California

with how to take care of those inmates.

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

about releasing some inmates toprivately run secure nursing homes.

According to government statistics,people over 55 have less

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

to commit another offense and return to prison.

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

for federal health care subsidies.

KELSO: One way or another health care needs

of these people are goingto be paid for by somebody.

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

If they're not rehabilitated absolutely.

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

Where are they going to go?

What are you going to do with them?

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

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

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

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

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

FARYON: Do you ever think you will get out?

CAMPBELL: No.

No I don't.

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

You know, that applies.

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

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

when I came to prison, who are still here.

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

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

How do I prove myself andwho do I prove myself to?

And there's no answer.

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

And you can also leave a comment.

We'd love to hear from you.

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