--Hello everyone. I'm Joanne Faryon.

Welcome to this Envision special

Life In Prison

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

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

over the course of their sentences.

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

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

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

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

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

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

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

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

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

At first glance this could look like a nursing home.

The wheelchairs and walkers have a way of fooling you.

This is the California Medical Facility, 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 sick inmates are growing in number.

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

from our economy to our safety to our health - 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 so did a federal court in 2002.

There are 170,000 inmates in prisons 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-degree murder, and I've been in prison for 44 years.

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

I've been here 23 years.

--And how old are you?

And I'm 63 years old.

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

--Why?

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

--Richard Lauranzano represents 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 at hospitals outside the prison system.

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

The prison system saved my life.

They sent me to outside hospitals they never hesitated.

--Glenda Virgil has had surgery.

VIRGIL: I've had major back surgery.

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

I can't imagine what that cost.

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

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

--Terry Campbell has had seven operations.

CAMPBELL: My back.

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

My hand, twice.

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

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

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

we have the results of Hepatitis C, there was ephydemic exposure in the 80's,

we began to see the results of that now.

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

as the result of an abuse of drugs and alcohol.

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

that simply require a different type of care.

--A federal judge made Kelso a receiver

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

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

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

and violated inmates' constitutional rights.

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

to reduce its prison population by 40,000 inmates.

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

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

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

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

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

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

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

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

Once you have incarcerated someone, government has a constitutional obligation

under the 8th amendment to provide certain levels of acre

and that what the state has to do.

--Since the receivership assumed control of health care

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

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

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

to its growing geriatric population.

One independent report projects the number of men

in California prisons over age 60 will triple by 2018.

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

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

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

that needs to realize those decisions come with a cost

that you can't have a prison population 16 or 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 of the general fund to their health care

because those aging prisoners are going

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

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

Using government statistics, KPBS calculated 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 health care expenses will increase.

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

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

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

FARYON: So, when you were first convicted and 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 change while you're in prison and prove to us

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

showing us that you've rehabilitated and the CDC staff supports

that effort, then you will be paroled.

--Lifers rarely get parole.

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

The board granted 294.

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

In 2008 Governor Arnold Schwarzenegger denied 81 lifers parole

and sent more than 30 cases back for review.

Fewer than 60 inmates were released.

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

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

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

At the time homicide rates were on the rise -

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

HARRIET SALARNO: Because the high crime,

murder was on the rampage and people were getting furious.

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

She and her husband owned an electronics store.

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

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

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

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

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

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

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

for tougher sentencing laws and stricter parole policies.

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

SALARNO: Public safety is in our constitution

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

We will back right there lobbying as heavy

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

because somebody was murdered it will be on 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 laws in the last few decades have all contributed

to California's highest rate of lifers in prison.

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

which imposed minimum sentences, and three strikes in 1994,

which allowed repeat offenders to 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, plus two for a gun allocation.

And I've been here for 23 years.

FARYON: And Marylinn?

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

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

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

LINDA: The change is for me my health.

My health has declined and the getting around 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't get down or get up anymore, or my legs.

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

wow I'm 70 years old and I don't even have a retirement plan.

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

That's what you have to do.

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

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

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

inmates over 55 who are granted special 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 the floor when an alarm sounds.

This happened while we were there.

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

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

for mobility-impaired people to get around.

Prisons were built to safely incarcerate individuals whoa re sent away

and keep them from escaping.

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

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

Simple things like getting their clothes 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 been working as a prison doctor for 20 years.

He tends to patients at CMF's hospital 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 particularly interested in knowing.

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

to provide the best quality of health care I can.

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

by knowledge of someone's commitment offense.

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

Angelo Chavez has end-stage liver disease.

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

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

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

His convictions include drug possession, robbery and manslaughter.

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

FARYON: We also met Brian Long.

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

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

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

In California, inmates can be released 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 have very strong opinions on all sides

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

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

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

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

of their life in prison.

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

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

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

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

HIV and hepatitis and tuberculosis and mental illness

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

to somehow ignore them an put them off there and assume

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

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

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

CAMPBELL: I'll just grow old 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 function anymore and eventually I'll end

up in a hospital and eventually I'll die.

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

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

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

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

Since that time Campbell has earned two college degrees FARYON:

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

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

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

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

for what reason other than personal satisfaction.

I can't give anything back.

VIRGIL: And being alone.

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

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

and killing the man with whom 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 penalty they 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 should get out and be a functioning member of society.

FARYON: Richard Lauranzano was convicted of seven counts

of sexual assault with children under 14 in 1984.

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

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

Lauranzano's cancer is in remission, 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 and only 7.5% goes to higher education.

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

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

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

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

and inmates who need mental health services are now underway.

There isn't room for them anywhere else.

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

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

and dying inmates accounted for most of that cost.

KELSO: There are solutions I think the legislature

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

of programs that will get these unhealthy inmates these again inmates

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

we have to come to a better public understanding in California

with how to take care of those inmates.

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

about releasing some inmates to privately run secure nursing homes.

According to government statistics, people over 55 have less

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

to commit another offense and return to prison.

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

for federal health care subsidies.

KELSO: One way or another health care needs

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

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

If they're not rehabilitated absolutely.

HARRIET: What are you going to do 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 to commit a crime if they can't get a job

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

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

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

You just don't open the door here'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 where you are, but it always matters who you are?

You know, that applies.

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

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

when I came to prison, who are still here.

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

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

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

And there's no answer.

FARYON: You can learn more about this issue by 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.