America’s Crisis of “Death by Incarceration”

Aging Inmate Population Prompts Review of Medical Services and Release Options

The United States prison population has grown older in recent decades, with state and federal facilities reporting increased numbers of inmates over age 55. Incarcerated individuals in this age group often require more frequent medical attention for chronic conditions.

Donald “Don” Snook, 73, has been held in Washington state facilities since 1975. He currently resides at Stafford Creek Correctional Center, where he uses a wheelchair and compression socks. Medical records indicate he has experienced four strokes and lives with chronic lung disease and an untreated cardiac blockage estimated at 80 percent. In 2019 he received a colon cancer diagnosis that had reached stage III by the time treatment began; a subsequent prostate cancer diagnosis followed.

Washington operates an Emergency Medical Placement program that permits certain seriously ill inmates to serve remaining time in community medical settings. Eligibility rules exclude individuals serving life sentences without parole. Snook has described delays of several months for specialist appointments and has received assistance from other inmates for daily tasks when nursing staff were unavailable.

Data from the Bureau of Justice Statistics show the share of state and federal prisoners aged 55 and older rose from roughly 3 percent in 1991 to higher levels in later years, though exact national percentages vary by reporting year and jurisdiction. Researchers have attributed accelerated health decline in some cases to a combination of pre-incarceration factors such as poverty or trauma and the conditions of confinement itself.

Christian Gonzalez-Rivera of the Roosevelt House Public Policy Institute has noted that prison medical services frequently operate under constrained budgets, resulting in higher per-inmate costs once advanced care becomes necessary. Published estimates of annual incarceration costs range from approximately $30,000 to $70,000 for younger adults and from $70,000 to $240,000 for older adults, depending on the state, facility type, and specific medical needs documented in legislative and academic reports.

Marc Stern, a physician who has worked in Washington correctional settings, has stated that sentences imposed by courts specify loss of liberty but do not include deterioration of health from inadequate treatment. Snook’s case illustrates the intersection of these issues: he was convicted of first-degree aggravated murder after incidents inside Walla Walla prison in the 1970s and received a life-without-parole term.

In Pennsylvania, Irvin Moore, released in 2021 after 52 years for first-degree murder and aggravated robbery, described infrequent medical examinations during his later years of incarceration. He reported receiving checkups roughly twice after age 75. Moore and others have pointed to instances in which symptoms were initially attributed to minor ailments before more serious diagnoses emerged.

Gonzalez-Rivera has described delays in identifying chronic conditions as a recurring pattern across multiple facilities. Stern has added that staffing models sometimes assign complex diagnostic tasks to physician assistants or licensed practical nurses rather than physicians or registered nurses, citing recruitment difficulties and compensation levels.

Colin Creveling, a registered nurse supervisor at Pennsylvania’s Laurel Highlands facility, has linked prison medical staffing shortages to broader post-pandemic workforce trends in health care and to the specialized nature of correctional work. Most states contract with private vendors for prison health services; these contracts operate outside Affordable Care Act requirements for preventive screenings.

Ruth Greenberg, an attorney involved in Massachusetts medical-parole litigation, has observed that contractors evaluate projected treatment costs before approving referrals. Transporting an inmate to an outside hospital typically requires two officers, adding expense that can influence decisions about non-emergency procedures. Snook’s prostate cancer treatment occurred after a reported 17-month interval.

Dental services illustrate similar resource allocation patterns: extractions are often less costly than restorative work, leaving some inmates with multiple missing teeth. Loretta Pierre, incarcerated in Mississippi since the 1980s, waited five years for an appointment scheduled in 1997.

The United States holds more than 56,000 individuals serving life-without-parole sentences, the majority for first-degree murder convictions according to sentencing data compiled by the Sentencing Project and state corrections departments. This figure represents the large majority of the world’s LWOP population. Eligibility for medical or compassionate release programs is restricted in many jurisdictions precisely because of the offense categories involved.

A 2016 analysis later attributed to the Brennan Center estimated that a substantial portion of the U.S. prison population—approximately 40 percent or 600,000 people at the time—served sentences without ongoing public-safety justification under certain recidivism metrics. Separate studies have examined recidivism rates after release of older inmates, though outcomes differ by jurisdiction and offense history.

International comparisons show shorter average sentence lengths in countries such as Germany, Norway, and Finland, where policy emphasizes rehabilitation and reintegration. Recidivism figures in those systems are frequently lower than U.S. averages, though direct causation remains debated among criminologists.

Michele Deitch of the Prison and Jail Innovation Lab has noted that the United States maintains longer sentences than peer nations for comparable offenses. Carole Cafferty, a former Massachusetts jail administrator, has contrasted U.S. emphasis on retribution with restorative-justice models used elsewhere.

Greenberg has represented clients whose compassionate-release petitions were denied despite documented terminal illness or severe disability. Some individuals died shortly after denial. Cafferty has argued that expanded victim-support services could reduce opposition to medical parole by addressing grief and safety concerns.

Shneaqua Purvis, whose sister was killed by a stray bullet in 2002, later mentored the individual convicted in that case after his release and testified in support of New York’s Elder Parole and Fair & Timely Parole proposals. Luz Marquez Benbow, who survived multiple sexual assaults, has similarly advocated for policy changes that prioritize behavioral accountability over continued incarceration of medically frail individuals.

Jonathan Kirkpatrick, who served alongside Snook for 17 years, has described Snook as unlikely to pose a physical threat if released, though not positioned to contribute economically. At Stafford Creek, Snook continues to manage memory changes by writing reminders and playing Sudoku.

State departments of correction have cited HIPAA restrictions when declining to comment on individual medical cases. Proposals to expand medical parole or adjust LWOP eligibility remain under legislative consideration in several states, with outcomes dependent on public-safety data, cost projections, and victim-input frameworks.