A Life Sentence of Expense

Steven Martinez lies in bed in a small, bare room, day after day, month after month. He can blink, speak, swallow and turn his head. Nurses must help him with everything else.

They bathe him, turn his body every two hours and spoon-feed him three meals a day. When he wants to make a phone call, a staff member dials the number and holds the receiver to his ear.

His care comes courtesy of the California penal system. Convicted of rape and assault in 1998, Martinez was sent to prison for the rest of his life. Two years ago, fellow inmates stabbed him in the neck, leaving him a quadriplegic.

Corrections officials say Martinez, 34, may be California’s most expensive inmate. His hospital cell in the high-security prison here costs $730 a day -- not counting medical procedures, drugs and the salaries paid to his guards. Last year, a bedsore carved a crater in his back, requiring surgery and six months in a private rehabilitation center. The bill: $620,139, nearly half of which was paid to two corrections officers who watched him around the clock.

If he lives another 30 years, just meeting his basic needs could cost California $8 million or more.

Martinez is one of about 120 state prisoners who need help with bathing, eating and other functions of daily life. Some are paralyzed or missing limbs; others suffer from brain injuries or Alzheimer’s disease. Thousands more are old, feeble or gravely ill.

The state’s budget crisis is prompting questions about whether the expense of incarcerating such inmates can be justified when legislators are contemplating cuts to child care centers, aid for the blind, community colleges and other programs.

The leader of the state Senate, Democrat John Burton of San Francisco, thinks not.

In his view, convicts hobbled by disease or disability belong in lower-cost settings, perhaps nursing centers with minimal security. Some could be released outright, the senator said, or monitored in their homes by using electronic bracelets.

“What are these guys going to do? Run you over with their wheelchairs?” Burton asked. “There has to be a better way to deal with them, a way that saves money without threatening public safety.”

Martinez’s parents make much the same argument. They are pushing to have him moved to a private medical facility or released to their home in San Diego. They have sued the Department of Corrections, accusing it of medical malpractice and arguing that their son cannot get adequate care behind bars.

Most states have laws permitting the medical release of felons deemed unlikely to commit new crimes. Some states, under budgetary pressure, are expanding the definition of who qualifies so they can thin out their prison populations. Missouri frees those who require nursing home care; Arkansas paroles inmates with permanent physical or mental disabilities.

In California, which has the nation’s largest inmate population, prisoners can apply for “compassionate release.” But the criteria are stiff: A convict must be judged terminally ill and within six months of death. Last year, 39 prisoners were considered for compassionate release and 12 were freed.

“You may not have to be standing at the Pearly Gates to qualify, but you have to be able to see them from where you are,” said Jonathan Turley, a law professor at George Washington University and an expert on elderly and infirm convicts.

Sen. Denise Ducheny (D-San Diego) has put forth legislation (SB 278) to allow medical parole of incapacitated convicts. Gov. Gray Davis has been silent on the bill, which passed its first legislative test in early April, but he opposes freeing any inmate simply to save money.

For Martinez’s victim, talk of an early release is unsettling. A nanny in San Diego, she said she has struggled with the trauma of the assault, and is only now getting her life back on track.

Five years ago, a drunken Martinez knocked the woman to the ground with his truck while she and a friend were walking outside a San Diego nightclub. He then abducted her, drove to an isolated area near Mission Bay and raped her.

Martinez, a San Bernardino native who had previously served prison time for assault with a deadly weapon, was given double penalties for the new crimes, leading to a sentence of 165 years.

“I’m already nervous all the time, always watching my back,” said the victim, whose name is being withheld because of the nature of the crime. “If he was out, that would all be worse.... I don’t think I deserve that.”

Martinez, who is appealing his conviction, applied for compassionate release in 2001 on grounds that his care is unusually costly and difficult, and that he is no longer a threat. The prison warden supported the request, citing a doctor’s conclusion that Martinez “cannot hurt a fly.”

But the director of corrections, Edward Alameida, rejected it, saying Martinez’s condition “does not negate the seriousness of his commitment offense or justify his early release.”

Prison officials acknowledge that California could save money by moving inmates such as Martinez into lower-security settings.

The chief of medical services for the penal system, Michael Pickett, said he has been working for months to shift 100 inmates, including quadriplegics, out of prison hospitals and into private nursing facilities staffed by corrections officers.

Moving those felons would free prison beds for sick inmates who are now being sent to community hospitals at great expense, Pickett said.

“Would we save money with these contract beds? Yes,” said Pickett, though he said he could not estimate how much. “We are moving in that direction. I think at some point we’ll get there.”

The question of simply freeing such prisoners -- as the Ducheny legislation envisions -- is more complicated.

Dr. Michael Bendon is chief medical officer at Corcoran State Prison, where four quadriplegics live, including Martinez. Bendon said that while a paralyzed man may “seem helpless, he could still direct a gang with his mouth. He could still order a killing.”

There also is public opinion to consider. Of the state’s 120 incapacitated felons, 30 are convicted murderers. Another 25 are behind bars for manslaughter, rape, robbery, kidnapping or sexually abusing a child.

“I can tell you,” Pickett said, “that there are a whole lot of people out there who will say, ‘We don’t give a damn what their medical problems are. They ought not be on the street.’ ”

Larry Brown, executive director of the California District Attorneys Assn., holds that view. “It would be an outrage to the victim and to the justice system,” he said, to use budget problems to reduce Martinez’s sentence “or in any way weaken our criminal laws.”

The Department of Corrections, with more than 159,000 prisoners, is a massive provider of medical services, treating inmates for conditions ranging from cancer to schizophrenia.

In addition to dispensing in-prison care, the department transports thousands of convicts to private hospitals for surgeries, dialysis and other treatment. This year, the department will spend $886 million on inmates’ medical needs, a figure expected to rise to $939 million in the 2003-04 fiscal year.

Martinez, a former construction worker who has two sons, ages 5 and 10, is the most “care-intensive” convict in the penal system, said Ken Hurdle, an ombudsman for the department.

Martinez was attacked by two other inmates while standing beside a baseball field at Centinela State Prison, in Imperial County, in February 2001.

Corrections officials, citing security concerns, would not allow The Times to see or photograph Martinez, his cell or the hospital wing at Corcoran. A department spokesman agreed to give Martinez a reporter’s phone number and permit him to make a prison-monitored call, if he chose to. No call was received.

Officials familiar with his case said Martinez lives in a locked room beside the nursing station, with a large window so the medical staff can watch him at all times. He can turn his head to activate a call button, and has a television but no ability to change channels.

His parents spent more than $300 on a device, held in the mouth, that would enable him to turn the pages of a book, but prison officials will not allow him to use it. A table to hold the books would take up too much space in his room, they say.

Martinez receives some physical therapy, and is occasionally wheeled onto a small, concrete patio for a bit of fresh air, Hurdle said. Other than that, he remains in bed. He takes antidepressants and other medications and has filed a string of complaints against staff members. Some claim that nurses are slow to respond to his needs. One accused a guard of making choking motions in what Martinez perceived as a threat on his life.

Officials said they are investigating the grievances, but defend the treatment they provide.

“It’s not Cadillac care, like Christopher Reeve gets,” Hurdle said, referring to the “Superman” star who has been a quadriplegic since a 1995 riding accident. “But the Corcoran staff are highly committed to giving this guy the treatment he needs. He won’t ever get well, but they’re doing their best.”

Martinez is an insulin-dependent diabetic, which complicates his care and puts him at great risk of developing pressure sores. In December 2001, Martinez developed a bedsore on his lower back that eventually reached the bone, medical records show.

After undergoing surgery at an outside hospital, Martinez was sent to a rehabilitation center in Pomona, where he received six months of physical therapy, psychological counseling and care for the sore. Two corrections officers watched him 24 hours a day, at a cost of about $30 per hour -- $275,697 in all.

Attorneys for Martinez contend that the bedsore was caused by medical neglect and that further complications -- perhaps fatal ones -- are inevitable.

Charles and Norma Martinez said their son’s complications are proof that the penal system cannot meet his medical needs. They have devoted their retirement to lobbying prison officials, faxing pleas to legislators, keeping scrupulous records of his care.

Once a month, they make the 350-mile trek north from San Diego to see their child, bringing his two boys along when they can. They have refinanced their house three times to pay attorneys’ fees, and hope California’s budget crisis may open the door for their son to come home.

“Even if he’s released today, it’s not like he can put on his shoes and play basketball. He is physically destroyed for life,” Norma Martinez said. “They can hate our son, they can hate us, but he’s paid a steep price.”

Prison officials said freeing inmates such as Martinez would not reduce the cost of caring for them. Rather, they argue, the burden would simply be shifted from the taxpayer-supported corrections system to the taxpayer-supported Medi-Cal or Social Security system.

Advocates for disabled and elderly convicts dispute that. They say health care can be delivered far more efficiently outside prison, resulting in much lower costs, no matter who pays them. When convicts are taken to outside hospitals for treatment -- a regular occurrence -- state regulations require that they be watched around the clock by at least two corrections officers. A veteran guard makes $54,888 a year, not counting overtime and benefits.

“It is ridiculous to argue that California would not save substantial amounts of money by relocating these incapacitated inmates out of the correctional setting,” said Turley, the law professor. “It’s the primary reason many states take this step.”

When the woman Martinez raped learned from prosecutors that he was paralyzed, she thought it was unlikely he could hurt anyone again.

“I thought, ‘Well, he’s harmless now. He might as well go home and let his mom take care of him,’ ” the woman said.

Gradually, however, her thinking changed as she considered the possibilities of medical research aimed at healing spinal cord injuries.

“What if, 10 or 20 years from now, he’s out walking around? He’s an angry guy. I don’t know what he could or would do, and I don’t want to find out.”