A degenerative nerve disease has left 57-year-old California inmate Edward Ortiz semi-paralyzed in a private Bay Area hospital for the last year. The breathing tube in his throat tethers him to a ventilator at one end of the bed; steel bracelets shackle his ankles to safety rails at the other.
Still, California taxpayers are shelling out roughly $800,000 a year to prevent his escape. The guards watching Ortiz one day last week said department policy requires one corrections officer at the foot of his bed around the clock and another guard at the door. A sergeant also has to be there, to supervise.
"Some of this is ridiculous, but you can't argue with policy," said Corrections Officer Allan Roper as he stared down at the unconscious Ortiz, a convicted child molester who requires medical attention beyond the prison system's capabilities.
Authorities have identified 25 "permanently medically incapacitated" inmates being treated at outside hospitals who are candidates for parole because they no longer pose a threat to the public. Californians will pay more than $50 million to treat them this year, between $19 million and $21 million of that for guards' salaries, benefits and overtime, according to data from the federal receiver who oversees California prison healthcare.
The final amount will depend on how many of the guards are paid overtime.
In September, then-Gov. Arnold Schwarzenegger signed a "medical parole" law designed to spare taxpayers the cost of guarding inmates like Ortiz and dozens of others who officials say are incapacitated. Some are in comas, others paraplegic.
If the prisoners were released from custody, the medical costs would shift to their families if they could afford to pay, or to other government programs if they could not. The expense of guarding the patients would be eliminated.
But the California Department of Corrections and Rehabilitation has yet to schedule a parole hearing for even one such inmate.
"It's maddening," said State Sen. Mark Leno (D- San Francisco), who sponsored the bill that Schwarzenegger signed. "We have school districts on the verge of closing" because of the state's budget crisis. "We don't have millions of dollars to squander on this kind of nonsense."
Terri McDonald, chief deputy secretary of adult operations for California prisons, said her department had been working with the receiver, appointed in 2005 after a federal court found that healthcare in the state's prisons was tantamount to "cruel and unusual" punishment, to draft regulations to implement the new law.
Despite those efforts, McDonald would not predict when the first sick inmate might get a parole hearing. "These are complex public-safety regulations," she said.
Nancy Kincaid, spokeswoman for receiver J. Clark Kelso, said Kelso is "anxious to have these regulations in place so we can maximize savings."
Leno said he introduced the medical parole law to address concerns about the existing statute that allows "compassionate release" of prisoners who are permanently incapacitated or terminally ill with less than six months' life expectancy.
Compassionate release has the same legal effect as completion of a prison sentence, meaning the former inmate can't be sent back to prison unless he is convicted of another crime.
Opponents of that system pointed to the notorious case of the Lockerbie bomber, the Libyan terrorist who blew up a Pan Am flight in 1988, killing 270, but was released from a Scottish prison in 2009 when doctors thought prostate cancer would kill him in less than three months. He was still alive a few days ago, according to published reports.
An inmate freed on medical parole in California, however, would be sent back to prison if his physical condition improved enough that he could pose a reasonable threat to public safety.
Partly because of the concern that an inmate could cheat justice by outliving a prison doctor's prognosis, the odds have not favored inmates petitioning for compassionate release.
Seventy percent of the 1,157 prisoners determined by doctors to qualify between 1991 and 2010 were rejected for compassionate release, often because top prison administrators or sentencing judges believed they could still pose a threat.
Although some able-bodied inmates have tried to escape while on outside medical appointments, corrections department officials could not cite any who had succeeded. Reducing the guard on such patients, even the most incapacitated, invites risk, said prison spokesman Oscar Hidalgo.
"And we are not in the business of taking risks with public safety," Hidalgo said.
Thousands of inmates are treated at outside hospitals during the course of a year. Although a broken arm can usually be set and splinted at an internal facility, surgery is often done at outside hospitals, said Joseph Bick, chief medical officer of the state's largest prison hospital, in Vacaville.
Last week, at least 12 guards were on hand to oversee five patients at the Bay Area hospital where Ortiz resides. Administrators there allowed reporters to visit on the condition that the institution's name not be published because of security concerns.
The guard detail consisted of two officers assigned to each inmate, a supervisor and "a security escort in case they have to go to the shower," said Lt. Rudy Luna, administrative assistant to the warden at nearby San Quentin. The extra guards also escort patients for X-rays and other medical procedures.
McDonald said the guards' interpretation of department policy was "inaccurate" — that the number of corrections officers required to watch inmates when sent outside of prison walls is flexible, depending "on the number of offenders, the clustering and location of those offenders to each other and the security risk of those offenders."
The written policy is in a section of the department's operating manual that is not available to the public because of "very legitimate security reasons," McDonald said.
Inmates are sent to outside hospitals when their medical condition requires specialized treatment. One prisoner last week was receiving physical therapy after a knee replacement. Others, like Ortiz, were in advanced stages of debilitating, hard-to-treat diseases.
Corrections officers vie for coveted positions on medical guard teams, with the choice assignments usually going to those with the most seniority. Several guards at the Bay Area hospital said they had between 20 and 30 years of experience in the department.
Roper, who was assigned to watch Ortiz, said he'd spent the first 24 of his 27 years as a corrections officer at San Quentin, which houses California's death row, and prefers the relative calm of the hospital.
"In San Quentin when things go bad, they go real bad," Roper said, gesturing to the prone Ortiz, who can't speak even when he's awake because of the breathing tube. "Here, there's not the verbal abuse that you get at San Quentin."