Opinion

5 posts

Time for medical release law for terminally ill inmates in Massachusetts

Below is an op-ed I co-authored with Senator Pat Jehlen on why Massachusetts should release terminally ill inmates from incarceration to a supervised community setting in cases where a judge has determined that an inmate is permanently incapacitated and no longer poses a public safety concern. Sen. Jehlen and I filed legislation in the Senate and House, as S.843 and H.1628 respectively, that would accomplish this smart-on-crime approach. I have also filed similar language as an amendment to the House FY17 Budget, which will be debated this week. The op-ed ran in Cambridge Day titled “Time to move terminally ill, aged convicts from ill-equipped prison, jail care facilities.” – Tim

There is a fiscal crisis looming over Massachusetts’ state prisons and county jails. The inmate population is aging, and the cost of providing health care to older inmates, particularly those who are suffering from terminal ailments, is beginning to strain budgets. We incarcerate twice as many inmates over the age of 50 as we did in 2002, and this trend shows no signs of slowing. This is a problem that is shared in corrections systems across the country, but unlike most other states, our jails and prisons do not have access to the tools they need to deal with it.

Forty-five other states and the federal government have mechanisms for releasing dying prisoners in their custody to more medically appropriate environments. Massachusetts is one of the five states that do not have such a mechanism, and it is costing us dearly. Continuing to imprison dying inmates who no longer pose a danger to the public is pulling funds away from corrections initiatives that directly affect public safety, such as programming for inmates nearing release. Rising health care costs and an aging inmate population guarantee the situation will only continue to grow worse unless we take action now.

To address this problem, we filed legislation that would create a process for the Department of Corrections and County Sheriffs to begin placing terminally ill and permanently incapacitated prisoners who are no longer a threat to public safety in settings outside of state prisons and county jails. If passed, this bill would allow eligible inmates to begin receiving end-of-life care in facilities such as hospices and would transfer responsibility for care costs from the corrections system to public or private health insurers.

Since most inmates would be eligible for Medicaid upon release, this bill would generate significant cost savings for the state and county corrections systems. The same medical care could be paid for at a lower cost by Medicaid, and the state would also get significant federal reimbursement for the cost. Inmates could be monitored safely and securely in medical release settings through the use of GPS bracelets and home visits, rather than the multiple corrections officers that are currently required, further reducing the strain these inmates place on resources. Any threat to public safety under such a law would be highly remote – sheriffs and the Department of Corrections would have discretion over which inmates to refer to the program, and courts would have broad authority to set release restrictions. In the event an inmate’s medical condition unexpectedly improved or they violated the conditions of their release, they would be returned to custody.

While we feel the evidence leans heavily in this bill’s favor, obtaining a broad base of political support for this legislation remains a challenge. Some continue to hold the belief that inmates deserve little besides punishment, even if that punishment includes the indignity of dying in a prison cell. We readily understand and accept this anger, especially when it comes from victims of crime. But we have seen the inmates who would qualify for medical release under our bill. They are frail – often bedridden – with some suffering from advanced dementia. There is no rational purpose for continuing to expend resources to lock these men and women behind bars and razor wire, especially when every dollar we expend on their care is a dollar we cannot expend on preparing healthy, able-bodied men and women finishing their sentences to lead lives free of substance abuse and crime.

Right now, there is a clear commitment among members of the House and Senate to making smart criminal justice reforms. Just last week, Gov. Charlie Baker signed a repeal of the lengthy mandatory driver’s license suspensions and severe reinstatement fees that had long been imposed on drug offenders – even for those whose crimes did not involve a motor vehicle. Bills tackling issues such as mandatory minimum sentencing and the pretrial bail system have attracted dozens of co-sponsors, and there is a clear appetite on Beacon Hill to engage with these issues in a substantive and progressive manner. In this environment, we have a great opportunity to join 45 other states, the District of Columbia and the federal government by implementing a medical release system in Massachusetts. When looking at our options, it is one of the clearest, most rational choices we can make for our criminal justice system.

Why Single Payer should be the next step for healthcare reform in MA

SinglePayer_testimonyEarlier this week, I testified in support of H.1026, An Act establishing Medicare for all in Massachusetts, which was heard before the Joint Committee on Health Care Finance. I wanted to share with you my testimony on why I think a single payer model should be the next step in health care reform in Massachusetts – Tim.

“Mr. Chairman and members of the Committee, thank you for the opportunity to testify today in support of H.1026, an Act establishing Medicare for all in Massachusetts.

I am very proud of the work we have done here in Massachusetts to reform our healthcare system so that more of our state’s residents have access to high quality, affordable care. We have led the nation in our efforts to reduce the number of residents who are uninsured or underinsured, and have passed innovative and forward-thinking legislation that attempts to slow rising costs.

I am here today because I believe that it is vitally important that Massachusetts continues its national leadership in the area of healthcare reform. The next step for our state can and should be a transition toward a single-payer system.

A single-payer system will help us achieve many of the goals that we have for our health care in Massachusetts, and solve many of the problems we continue to struggle with under our current insurance and payment system. It would significantly enhance our ability to rein in health care costs, and would provide every single person in our state with high-quality, deductible-free coverage.

We already know how well Medicare works when it comes to delivering health care efficiently to millions of Americans. Private insurers simply cannot compete with government when it comes to minimizing administrative and management costs. And this legislature has already recognized the potency of the global payment model to reduce the cost of care and radically change the way providers think about how they approach health, wellness, and the treatment of illness. Single payer would rapidly accelerate our transition toward the global payment model.

I believe that we are ready for single-payer, that we need single-payer, and above all, that our state’s residents deserve a single-payer system.

I appreciate the consideration that the committee continues to give this bill and I thank you for the opportunity to testify in support of it today.”

Thoughts on Volpe and CRA Up-Zoning

Two zoning petitions are currently before the City Council that will dramatically increase the development potential in Kendall Square and East Cambridge. The first is best known as the Volpe Rezoning and the second is a petition by the Cambridge Redevelopment Authority (CRA) to increase the square footage of the MXD district by approximately 1 million square feet. In my opinion neither of these proposals will be ready for ordination by the end of the term and I do not plan on voting in favor of either one in its current form.

With the Volpe rezoning we have an opportunity to use 14 acres in the heart of Kendall Square to redefine what Kendall will be for future generations. It is a complicated petition for sure, due to the economics of the site and the need for the future developer to construct a new facility for the Federal Government. It is the sort of hypothetical development scenario they base graduate courses on at MIT. The economics of the site—the affordable housing component, the allowed heights versus open space, the cost of a new building—is the primary sticking point in this process, and frankly I have not been presented with a compelling enough case on this point to consider voting in favor of the petition.

NASA officials examine a model of the Electronics Research Center, which became the Volpe Center when it was transferred from NASA to DOT in the early 1970s.
NASA officials examine a model of the Electronics Research Center, which became the Volpe Center when it was transferred from NASA to DOT in the early 1970s.

More work needs to be done, more questions need to be answered, and more feedback from residents of East Cambridge and The Port needs to be incorporated. The East Cambridge Planning Team has spent many hours examining the proposal and have some thoughtful alternatives that should be considered or hard evidence needs to be presented to explain why that concept cannot be done.

Just across the street we are presented with a second up-zoning of the CRA parcels which would allow 1 million square feet of additional development. Again, I haven’t heard a compelling argument on why we should be considering an additional 1 million square feet at this location with 3 million square feet being proposed across the street at Volpe.

Perhaps with more information, discussion, and community feedback we can find a proposal that works for Cambridge’s future. These petitions are not there yet, and I will not be supporting them in their current form.