Outside the small town of Somerset, 70 miles southeast of Pittsburgh and just a twenty-minute drive from field where Flight 93 plunged to the ground on 9/11, doctors and nurses provide around-the-clock medical care to more than 100 elderly and chronically ill men, offering them everything from nutritional support to end-of-life care.

The patients exhibit many of the same ailments as patients in any other long-term care facility in the state, including respiratory ailments, Alzheimer’s disease, cancer and pulmonary disorders. But they share one significant difference: These patients are under the care of the Pennsylvania Department of Corrections, and even if their prognoses were to miraculously improve, many of them will still die behind these walls.

Welcome to the State Correctional Institution at Laurel Highlands, the Commonwealth of Pennsylvania’s only prison that is specially tasked with handling what is becoming a serious problem across the state and the nation: a surge in the number of sick and elderly prison inmates.

According to a report from Human Rights Watch released last month, the number of senior citizens under American correctional supervision is higher than it’s ever been, and growing at an alarming rate. The study found the number of state and federal prisoners that are 55 or older — the official threshold for old age behind bars — grew at six times the rate of the overall prison population between 1995 and 2010. The number of prisoners over 65, meanwhile, surged 63 percent — or 94 times the rate of the general prison population — in the three years prior to 2010.

Jamie Fellner, a senior advisor at Human Rights Watch and the author the report, blamed the increase on “tough on crime” policies such as mandatory minimum sentences, three-strikes laws and the now more than four-decades-long War on Drugs.

“Prisons were never designed to be geriatric facilities,” she said, “yet U.S. corrections officials now operate old age homes behind bars.”

The graying of Pennsylvania’s prisons

The Keystone State has not only followed the trend, it has exceeded it. According to HRW, Pennsylvania has the second-highest proportion of geriatric inmates in the nation, behind Oregon. At the end of 2010, there were 8,462 inmates in Pennsylvania’s prisons over the age of 50, representing 16.5 percent of the inmate population. A decade ago they made up less than 10 percent of all prisoners. Inmates over the age of 40, meanwhile, now represent more than a third of Pennsylvania’s total prison population.

“We have a lot of elderly prisoners because we tend to have longer sentences, and we have one of the largest populations serving life without parole, and who will be there until they die,” explained William DiMascio, executive director of The Prison Society, the nation’s oldest prisoner advocacy group. “As these prisoners get older — and they get older earlier because prison life is just harder than it is for people on the outside, so people tend to break down sooner — we hear of all kinds of problems mostly relating to access to health care.”

Pennsylvania is one of six states that denies parole to lifers, and according to the Sentencing Project, has the second highest percentage of inmates serving life without parole, behind Louisiana.

The number of people of all ages locked up in Pennsylvania has grown more than five-fold since 1980, and now exceeds 51,000 — with nonviolent offenders accounting for the bulk of the increase, according to Department of Correction statistics. Over the same period, spending per inmate has nearly tripled, and funding for the state’s prison system is now our third largest expense behind medical assistance and education. Health care costs average three to four times higher for inmates over 55 than for younger inmates, studies show.

Last year, Auditor General Jack Wagner joined lawmakers including Republican State Senator Stewart Greenleaf, a former Montgomery County prosecutor, in calling for an aggressive reform program that seeks to trim the prison population by promoting alternative-sentencing programs, among other things.

“While most economic sectors in the commonwealth remain mired in recession, prisons remain Pennsylvania’s largest growth industry,” Wagner said.

A reform bill sponsored by Greenleaf that would institute some of those changes passed the Senate and is currently making its rounds in the House. In the meantime, Pennsylvania is busy building three more prisons and expanding nine others, to the tune of $685 million.

Not your average old age home

SCI Laurel Highlands was opened in 1996 in buildings that once housed Somerset State Hospital to provide specialized services unavailable in the state’s other 23 adult male prisons (there are not nearly as many elderly or infirm female prisoners, who are housed at the state’s two female prisons, Muncy and Cambridge Hills.)

A minimum security facility, Laurel Highlands houses 1,382 inmates, according to the DOC, 412 of whom are over 50. The rest are younger inmates who require special medical treatment and healthy prisoners who work in food service, maintenance and janitorial services.

According to DOC spokesperson Susan McNaughton, the prison has two “skilled care units” housing a total of about 100 inmates, many of whom are transferred from other prisons. But not every old or sick inmate makes it to Laurel Highlands, she says.

“Our prisons have infirmaries that provide medical treatment in line with community standards, and those infirmaries are able to care for the prison population’s medical needs regardless of the age of the offender or the type of illness,” McNaughton explained. “We house inmates of all ages throughout our prison system.”

An average of 100 prisoners over the age of 50 die of natural causes every year across Pennsylvania’s prison system. While some states maintain special units for end-of-life care, McNaughton says Pennsylvania doesn’t have a dedicated prison hospice program; instead, she says medical personnel are trained across the system to deal with end-of-life issues, including palliative care for terminally ill patients.

But an ongoing study being conducted by the Penn State School of Nursing found that care behind bars differs in some important ways from similar treatment outside the prison system.

“For example, morphine drips are generally not an option,” said Dr. Susan J Loeb, a registered nurse and associate professor at Penn State who is leading the research, in an article published on the study. “Availability of food items such as puddings, ice creams or other special foods varies between institutions, and reportedly within each prison depending upon who is working at any given time.”

The Penn State team, whose work is funded by a $1.27 million grant from the National Institute of Nursing Research, is working with employees from six Pennsylvania prisons and the DOC in an effort to improve end-of-life care for inmates.

Compassionate Release

Inmates who are terminally ill and still have time left on their sentences have two choices: die in prison or hope they qualify for Pennsylvania’s recently introduced compassionate release program.

In 2002, the Pennsylvania Senate passed a resolution creating a task force to study the problem of the state’s aging inmate population. It took a year to get off the ground and another two years to complete its work, which culminated in a set of recommendations that included updating the state’s medical release law.

According to Senator Greenleaf, who chaired the panel, the existing law, which dated to 1919, was archaic, and applied only to prisoners who couldn’t be cared for in prison. Greenleaf said there was a general agreement on the panel that if a prisoner is terminally ill and not a risk to society there should be a consideration for early release.

“The average cost of caring for a terminally ill patient can run as high as $100,000 a year, which is the responsibility of the state, but if we release them to a private facility the federal government takes over,” he said. “But this was a public policy decision, so public safety had to take precedent over cost.”

Numerous studies show that older prisoners rarely re-offend once released, particularly those that have been incarcerated for an extended period of time, which most elderly inmates have. Data from the Pennsylvania Parole Board shows that of the 492 prisoners over the age of 50 that were released in 2003, only seven re-offended, a recidivism rate of just 1.4 percent.

In 2008, over the objection of some victim advocates, Gov. Ed Rendell signed a Correction Reform Package, Act 81, which included stringent new guidelines for medical release. Under the program, the corrections officials or the prisoner may petition a temporary suspension of sentence for release to a treatment facility or hospice only if it can be shown that the inmate will receive more appropriate care there, that they pose no threat to the community, and that they are seriously ill and likely to die within a year. If any of those circumstances change, authorities can petition to have the inmate sent back to prison.

McNaughton says approximately six inmates a year are released through the program. Similar programs in other states are notoriously under-utilized, according to prisoner advocates.

Asked if he thought the program he helped champion is working appropriately, Greenleaf said, “We put the mechanisms in place — but I can’t say at this point whether the mechanisms have been adequately utilized.”

Last Thursday, Gov. Tom Corbett signed five bills into law that would significantly affect the criminal justice system of Pennsylvania, among them a measure that gives Commonwealth judges more options when sentencing juveniles convicted of murder.

The proposed law, Senate Bill 850, which was originally introduced by State Senator Stewart Greenleaf, means that a juvenile 14-years-old or younger would serve 25 years for a first degree murder conviction and 20 years for a second degree homicide conviction. Defendants 15 to 17-years-old would face 25 or 35 years.

The bill, which Corbett signed into law last week, was Pennsylvania’s response to an earlier Supreme Court ruling in June that declared mandatory life sentences without parole for juveniles was unconstitutional. The Supreme Court’s ruling came after decades of research confirming that the frontal lobe of the juvenile brain — the part that controls reasoning, is undeveloped.

But, as significant a step as this legislation appears to be, some opponents say it ignores the spirit of the Supreme Court’s decision. Pennsylvania missed an opportunity to transform the harshest sentencing scheme in the world into one that is fair, proportional, and consistent with the latest knowledge of adolescent development, said William DiMascio, executive director of the Pennsylvania Prison Society.

“The Prison Society testified at an earlier legislative hearing on this issue and proposed that the state establish a sentence of 10 years to life for all juveniles,” DiMascio said. “The thinking was that a decade would enable the individual to reach maturity and to show his or her readiness for release.  Perhaps the minimum should be 15 years but certainly not more than 20.  Most likely few, if any, would get approved at their minimum by the Parole Board.  Nevertheless, the state would have control over them for life and could confine them until there was clear and convincing evidence that the person could be released without jeopardizing the community. Some will say a minimum of 10 years, or even 20 years, is not enough time.  Others will say life is not enough.  But this is not a test to see how tough we can be.  The way we develop our justice system is a measure of our civility.  We will be judged by the value we put on redemption, not retribution.”

On June 25, 2012 the U.S. Supreme Court ruled on Miller v. Alabama, the landmark case that addressed the constitutionality of juvenile life without parole. The court decided that these sentences were unconstitutional for juveniles convicted of murder’s committed when they were under 18-years-old. Right now Pennsylvania is one of the leading states in the nation with more than 400 juveniles sentenced to mandatory life without parole following conviction of either first or second degree murder.

Justice Elena Kagan said such sentencing is cruel and unusual punishment and therefore violates the Eighth Amendment of the Constitution.

"Mandatory life without parole for those under the age of 18 at the time of their crimes violates the Eighth Amendment's prohibition on 'cruel and unusual punishments',” Kagan wrote. “A judge or jury must have the opportunity to consider mitigating circumstances before imposing the harshest possible penalty for juveniles.

Under the new law, a juvenile defendant age 15 to 17 would receive a minimum of 35 years to life for a first degree murder conviction. The court would impose a sentence of 25 years to life for a defendant age 14 or younger. In cases of second degree murder or felony murder, where there is no evidence of intent to commit murder, such as the cases of Stacey Torrance and Robert Holbrook, the court impose mandatory minimum sentences of 30 years to life for 15-17 year olds, and 20 to life for defendants under 14.

Robert Holbrook was 16 when he was involved in an incident that escalated to murder. On Jan. 21, 1990, Holbrook was allegedly selling drugs for George Padilla. That night, Holbrook, Padilla and others agreed to rob Elsie Olmeda. They forced their way into her home and Olmeda was dragged upstairs. Holbrook stayed downstairs with the victim’s child while Padilla and the co-conspirators allegedly assaulted Olmeda and demanded money. After they found the cash Padilla and the co-conspirators decided to murder Olmeda to prevent her from identifying them. They allegedly tried strangling and then stabbing her. Later, Holbrook got an extension cord and threw it up to Padilla. Olmeda's hands and feet were tied and then she was repeatedly strangled and stabbed. Holbrook heard what was happening but didn’t go upstairs. Olmeda died from multiple stab wounds and strangulation.

During the trial, Holbrook pleaded guilty to third degree murder but the court found his actions showed intent to murder, even though he was the least involved.

Stacey Torrance was 14-years-old when he became involved in a robbery that led to murder in 1998.

Torrance was prosecuted for the murder of Alexander Porter, a young man who was Torrance’s girlfriend’s brother. Before this he had never been involved in any criminal activity. Two adults, Henry Daniels, his cousin, and Kevin Pelzer allegedly got Torrance to agree to participate in robbing Porter, whose family was allegedly involved in drug dealing and it was believed that they had a lot of money. Allegedly, Pelzer and Daniels murdered Porter, killing him with a .25 caliber handgun. Torrance had no prior knowledge of the murder and was not a participant. But he was convicted of felony murder or murder in the second degree. He was sentenced to life without parole.

Hundreds of thousands of inmates now in private prisons

In the last three decades, America has experienced an explosive increase in its prison population — more than 2.5 million inmates are now serving time — and that increase is attributable to a host of interrelated reasons from the failed War on Drugs to a lack of quality public education to a lack of comprehensive re-entry services and living wage jobs.

But since the late 1990s, another facet of the problem has begun to emerge — an increase in the number of private, for-profit prisons. Promising huge savings in taxpayers’ dollars, along with other financial perks, private prison corporations are becoming the alternative to expensive state facilities.

The Corrections Corporation of America, or CCA, one of the leading providers of for-profit prisons in the nation, recently sent letters to 48 states offering to buy their correctional facilities for a princely sum — $250 million towards the purchase of state prisons. In a time when the national economy is still limping and state budgets are shrinking, the state of Ohio found CCA’s “Corrections Investment Initiative” was an offer it couldn’t refuse.

The letter, sent by Harley Lappin, CCA’s chief corrections officer, and a former director of the Federal Bureau of Prisons, touted the corporation’s success with the program in Ohio and the millions in taxpayers’ money saved. The only caveat to the initiative was that the contract partner must agree to keep the handed over facilities 90 percent full. In other words, the state has the obligation to keep sending prisoners.

“CCA is earmarking $250 million for purchasing and managing government-owned corrections facilities. The program is a new opportunity for federal, state or local governments that are considering the benefits of partnership corrections,” Lappin wrote. “We’re proud to consistently deliver safe and efficient operations and high quality educational and rehabilitation programming for inmates and detainees under our care. Our decision to earmark funds for the purchase and management of existing government facilities follows our success last year in Ohio with the groundbreaking acquisition of the 1,798-bed Lake Erie Correctional Facility in Conneaut. On Jan. 1, 2012, we assumed ownership and management responsibility in a transition described by all parties as seamless. This transfer culminated a process that, according to state officials, generated more than $72.7 million in proceeds for Ohio taxpayers, about $50 million of which was allocated for the Ohio Department of Rehabilitation and Correction. Estimated annual savings in corrections operations are placed at $3 million.”

According to Lappin, CCA is also modernizing Ohio’s Lake Erie facility, retaining over 93 percent of the staff. Lappin wrote that Ohio would enjoy the full economic development of the public-private partnership that comes with a CCA-owned facility — and they want to build on that success.

“We want to build on that success and provide our existing or prospective government partners with access to the same opportunity as they manage challenging corrections budgets. Interested parties would execute the sale to CCA and enter into a long-term management contract of 20 years or more,” Lappin wrote.

Attempts by the Tribune to speak to officials at CCA were politely declined.

In order for a state facility to be eligible for CCA to purchase, it would have a 1,000-bed minimum, be no older than 25 years old, suitable for immediate occupancy or is already occupied by inmates, and “an assurance by the agency partner that the agency has sufficient inmate population to maintain a minimum 90 percent occupancy rate over the term of the contract.”

Could Pennsylvania, with Gov. Tom Corbett at the helm, be the next state to take the money and run? So far, it hasn’t happened, although according to Pennsylvania Department of Corrections spokesperson Susan McNaughton, there are a couple of counties with private facilities. Moshannon Valley Correctional Center in Clearfield County is one of them.

“Pennsylvania hasn’t gone the route of prison privatization because think we can do a better job and the cost savings, such as lower salaries, while they may be immediate, will disappear as salaries increase,” said McNaughton. “We went to Louisiana and looked at several private prisons there and came back and just decided we can do a much better job. It was that way under Governor Rendell, and remains so under Governor Corbett — we will not privatize our state facilities. Now there are some aspects of our prisons that we do privatize, such as drug and alcohol treatment, medical and mental health services — but that’s all we will consider.”

Right now, CCA manages approximately 75,000 inmates including men, women and juveniles at all security levels, in more than 60 facilities under contract for management in 19 states and the District of Columbia. The Geo Group, another private corrections corporation, manages approximately 80,000 beds and manages or owns 114 facilities.

CCA has no facilities in Delaware and only one in New Jersey, Elizabeth Detention Center in Elizabeth, New Jersey.

Experts have criticized the move to prison privatization, saying the cost savings don’t really pan out, and have raised concerns about inmate safety as well.

One guard was killed, and 19 other people including inmates were injured during a prison riot at a CCA owned facility in Natchez, Miss., on Sunday, May 20. In October 2011, 46 inmates were injured during a prison riot at another CCA run facility at the North Fork Correctional Facility in western Oklahoma. Fortunately, there were no fatalities.

Private prisons are not a new phenomenon; America has had them since the Revolution. But as the cost of incarcerating inmates continues to increase in a time of shrinking budgets and cost cuttings, the private prison industry has been expanding — holding more inmates and raking in huge profits. Private prisons for adults were non-existent until the early 1980s, but between 1990 and 2009 the number of private prisons increased by approximately 1600 percent. In 2010, the two largest private prison companies took in almost $3 billion dollars in revenue.

“Is it the new slavery? One could make an argument for that, certainly,” said attorney and former Philadelphia Prison Commissioner Leon King. “We’re talking about mass incarceration and companies like CCA are a symptom of a much larger problem. Do private prisons reduce the cost of incarceration? Perhaps over the short term, but when you look at the number of years of the contract, those costs will increase and our prisons are already overcrowded.”

Recently, the Sentencing Project released a study showing that the supposed savings generated by the utilization of private prisons was a questionable claim at best — and largely illusory.

“A 1996 report by the U.S. General Accounting Office (GAO) looked at four state-funded studies and one commissioned by the federal government,” said Chris Mason in the 2012 report, Too Good to Be True: Private Prisons in America. “The methodologies and results varied across the studies, with two showing no major difference in efficiency between private and public prisons, a third showing that private facilities resulted in savings to the state of seven percent, and the fourth finding the cost of a private facility falling somewhere between that of two similar public prisons. Another study also found significant cost savings associated with private prisons, but the GAO criticized the report for using hypothetical facilities in its comparisons. The authors noted that they could not definitively conclude that privatization would not save money, but also established that, ‘…these studies do not offer substantial evidence that savings have occurred.’”

Mason said in the report that the GAO’s critique of the methodologies used in comparisons is not unique. Former Bureau of Prisons Director of Research Gerry Gaes made similar observations when reviewing two reports that found different levels of savings when comparing the same three public prisons with a private facility. In his 2008 report for the National Institute of Justice he observed that the more favorable study for privatization did not adjust the data on the prisons to scale and failed to take into account the proper amount of overhead costs for the private prison. Gaes noted that these types of cost comparisons are deceivingly complicated and that current research is highly limited.

“We oppose prison privatization as a general matter because what a state is doing is essentially turning over control of its citizens to a private entity whose sole purpose is to make money off of human beings. Governor Tom Ridge said there would be no private prisons in Pennsylvania, ever — and we don’t have state facilities controlled or owned by private corrections companies,” said William H. DiMascio, executive director of the Pennsylvania Prison Society. “The overall problem is that generally, they can’t do a better job than the state. They’re going to have fewer staff, for less money, and usually in areas where there is no union foothold. Also, consider the fact that because they have to generate a profit for their shareholders, it’s in their interest to provide fewer programs to prevent recidivism. There is a direct correlation between prison programs and recidivism. It’s bad enough that we’re in an era of mass incarceration, but when it’s in the interest of a private entity to make a profit by incarcerating people, it then becomes the interest of the partner to be encouraged to incarcerate and criminalize offenses that would be better handled in other ways. It’s in the interest of the private entity to have high recidivism rates.”

Successful re-entry program lost state funds

Only highly structured and proven programs will help address the ramifications of the city’s high rate of incarceration and subsequent re-entry for area residents, state Sen. Anthony Hardy Williams contends in fighting for a $50,000 grant fora program that hits those marks.

Philly ReNew, an innovative, father-centered effort for ex-offenders pioneered by the Pennsylvania Prison Society, had been reduced to economic life support after its state funding was stripped, despite a success rate that surpasses 85 percent.

“It doesn’t make sense we have to beg to support these programs,” Williams said. “This grant is more than symbolism. It’s a lifeline. It’s a statement for Philadelphia and the surrounding region. If we don’t pay on the front side, we’ll pay $30, $40,000 per person, per year, on the back side.”

The Pennsylvania Prison Society has worked with former offenders throughout its 225 years of existence. State funding has withered, a trend this grant may yet reverse, said William DiMascio, executive director of the Prison Society.

“It seemed a little bit of pennywise and pound-foolish to cut a program that helped so many people get on with their lives,” he said.

Williams presented a ceremonial check to DiMascio and Ann Schwartzman of the Prison Society as he spoke before a group of Philly ReNew participating employers and clients.

The grant engineered by Williams not only offers a pulse of resuscitation, but also reaffirms the legitimacy of the program and its objectives, supporters said.

“The workforce of former offenders that I have hired is the hardest-working, most driven group that I have,” said Mark Boyd, CEO of Goodwill Industries of Southern New Jersey and Philadelphia. He has hired hundreds of former prisoners over the last five years, from various programs.

“Without that paycheck,” Boyd said. “The chances of reentering society successfully go down dramatically. There are a lot of people without four-year degrees who need to feed their families.”

Boyd encouraged other employers to hire former offenders. Williams echoed that sentiment.

“The ability to go to a ShopRite, or PECO, or PGW, gives skills that will follow them throughout their lives,” he said. “My uncle was never the man he thought he could be. We need fathers who can set an example for their children, on how they will conduct the rest of their lives.”

Philly ReNew, with its focus on parenting, mentoring, building relevant skills for ex-offenders, has a track record for substantively addressing these issues. More than 400 men have gone through the program in its three-year history.

Isean McNeil participated in the last cohort of Philly ReNew and talked about how devastated he and the other men were when they heard the bad news, knowing how effective the program had been for them.

“[Prisoners] need this program as I needed it when I came here,” said McNeil, who had spent 15 years in prison and is now a case manager at Shalom, Inc. Today, he works to help young people get off the streets and away from gun violence and interested in education and employment.

Philly ReNew is particularly relevant given the reality that the city’s fatherless households increasingly are the source of young people with greater entanglements with the criminal justice system.

“We, unfortunately, now have a legacy of 18-, 19-, 20- and 21-year-olds, if not 15-, 14- and 13-year-olds who now have records,” Williams said. “And we have a large number of people who are returning from prison. Some 30 percent of the state’s prison population comes from Philadelphia.”