A growing population of elderly inmates is driving up prison medical care costs to the point that some Texas lawmakers would like to see more of those who are feeble and chronically ill released early.

In the last decade, the number of inmates 55 and older has spiked as much as 8 percent each year, growing to about 12,500, while the general inmate population has remained fairly flat.

In prisons across the country, inmates grow old serving longer sentences and enter prison at an older age. Between 1999 and 2008, the number of inmates 55 and older in state and federal prisons increased by 76 percent to 76,400 inmates, according to the Federal Bureau of Justice Statistics. The general population grew by 18 percent.

With rising medical care costs and dwindling state budgets, policy-makers and prison officials have struggled to keep pace. Elderly inmates in Texas make up 8 percent of the state's prison population, yet they account for more than 30 percent of prison hospitalization costs.

In fiscal 2010, the state spent more than $545 million on inmate health care. It paid $4,853 per elderly offender for care compared with $795 for inmates under 55, according to the Correctional Managed Health Care Committee.

"It's no different than in the free world," said Dr. Owen Murray, chief physician and vice president of offender services for the University of Texas Medical Branch, which provides most of the state's prison medical care. "They're more expensive because they have more medical needs."

Legislators this session considered a bill that would have required release of certain elderly and sick inmates to community settings. Outside prison, many inmates would qualify for Medicaid, lessening the state's costs.

Required care

The legislation died after failing to make last week's calendar deadline. But lawmakers grapple with the issue every session. Inmates are constitutionally entitled to receive medical care, so states must balance the quality of care with its cost.

State Sen. John Whitmire, D-Houston, chairman of the Senate Criminal Justice Committee, said he would like to see prison space freed up for more dangerous criminals and the cost savings used for law enforcement. "In times of fiscal concern, we're spending $1 million or more on inmates who can't get out of bed or are really sick individuals. It's just nuts," he said.

Many prisons are not properly equipped to care for the elderly, said Robert Aday, a professor at Middle Tennessee State University and author of a book on aging prisoners.

"The sheer numbers are overwhelming them," Aday said. "A convergence of trends, including enhanced sentencing, more prisons built, and the graying of American people, it's created this crisis."

The Estelle Unit in Huntsville has a 60-bed geriatric unit where Raymond Palen, 79, has been housed for four years. He has diabetes, heart problems and arthritis. He moves around with the help of a walker and takes up to nine medications a day.

Palen, who has three years left on a 20-year sentence for sexual assault, has seen inmates die in what he calls the "old man's home."

Some states have turned to compassionate release and medical parole programs as ways to cut costs. But national statistics show that medical parole programs are under-used, Aday said.

In Texas, more than 1,000 offenders are identified each year as being eligible for medical parole, according to a Legislative Budget Board report. About a third of those are processed and presented to the state parole board, which approves 25 percent of those cases each year. Since 1991, 1,287 offenders have been released under the program — about 64 prisoners per year, the report said.

A long review process

The referral and review process for medical parole can be so long and complicated that many inmates die before their case goes to the parole board. In 2009, for example, 74 inmates died waiting for their case to be reviewed, the report said.

Inmates are referred for medical release mostly by physicians based on diagnosis and medical condition. The Texas Correctional Office for Offenders with Mental or Medical Impairments screens the referrals and presents recommendations to the Board of Pardons and Paroles.

The majority of medical releases are for inmates who are terminally ill or need long-term care, said Dee Wilson, director of the correctional office. Elderly inmates are rarely approved because a large percentage of them are in prison for committing sexual assaults and other violent crimes, Wilson said.

Inmates sentenced to death or life without parole or who committed certain violent crimes are not eligible.

Whitmire said he has tried in a few cases to appeal to the seven-member parole board to release an elderly and sick inmate who didn't pose a public safety risk, but he believes the board is too concerned about political consequences.

"We all want to save the state tax dollars, to think outside the box and to reduce cost where we can, but not at the expense of public safety," parole board chairwoman Rissie Owens said.

renee.lee@chron.com