Terminally Ill People Languish in North Carolina Prisons, Even After Reforms

“One doctor said I got two-to-four years left to live,” drawled 64-year-old James Davis in a deep southern accent. “Another give me three-to-five. They don’t really know. But one thing’s for sure: If I don’t get out, cancer’ll kill me in prison.”

Davis, a tall white man with wispy brown hair and a chest-length gray beard, is serving 31-35 years in North Carolina for a truck accident that killed an elderly couple and severely injured their adult daughter in 2007. Late one evening, Davis’ flatbed Ford F-350 veered off the road and T-boned the family’s smaller Chevy S-10 pickup. Following the crash, Davis registered a 0.09 blood alcohol concentration at the hospital, above the legal limit of 0.08. This led to two consecutive convictions for second-degree murder, which makes up the bulk of his sentence.

Doctors diagnosed Davis with prostate cancer in 2019. Radiation treatment sent him into remission, but in 2022, the cancer returned, spreading to his ribs, collarbone, pelvis and lymph nodes.

“It’s stage four,” Davis said in a dayroom at Neuse Correctional, a medium-custody prison in Goldsboro, North Carolina. Davis also suffers from Type-2 diabetes, osteoporosis, arthritis and hypertension. To hear, he has to cup his palm around his ear. To get around, he needs the help of a wheeled walker. His very existence appears labored and excruciating. “At this point, they’re not trying to cure me. I’m beyond that. They’re treating me until I die.”

Davis is just one of about 31,000 North Carolina prisoners who racked up a $357.4 million bill for health care in fiscal year 2021-2022, an expenditure that ballooned 51 percent over the past 10 years, according to NC Health News. Nationally, U.S. prisons spent $8.1 billion on prison health care in 2015 alone, as reported by Pew Trusts.

In an attempt to reduce the cost of prison health care in North Carolina, the GOP-run legislature in 2023 passed changes that make early release for medical reasons less stringent. Governor Roy Cooper, a Democrat who just left office at the end of December, signed it into law.

Under North Carolina’s medical release program, prison medical staff or representatives of a prisoner such as a family member or attorney can request that prison officials evaluate someone for medical release. If officials determine that someone meets the criteria, they can refer cases to the state’s governor-appointed parole commission, which makes the final decision. 

The changes lowered the age at which prisoners can be released for medical reasons from 65 to 55. To qualify, the prisoner must be so terminally ill, disabled or geriatric that they are medically incapacitated and determined by officials to pose no risk to public safety.  They must also have no more than nine months left on their sentence, whereas before the change, prisoners needed to be within six months of release to be considered. People serving time for murder, sex offenses, and other violent crimes still cannot apply.

Because of the second-degree murder convictions that resulted from his truck accident, Davis is not permitted to seek medical release in North Carolina. He is also excluded because there are many years left on his sentence. So he will remain in prison, incurring exorbitant fees for doctors visits and medication at taxpayers’ expense. Despite the disqualifications, Davis wishes he could be considered for medical release. “Because I’m dying,” he said.

Other states have medical release programs, and most codify variations of the same guidelines. All exclude people condemned to death row. On paper, New York allows infirm people convicted of anything besides murder to apply for release if they have served at least half of their sentence, yet prison officials routinely deny hearings for them to make their case. In Wisconsin, people with terminal illness whose sentences allow for parole can seek release after serving 10 years. Florida reserves the right to re-incarcerate someone previously released for medical reasons if doctors determine that their physical condition has improved.

The increase in life sentences that followed a wave of so-called tough-on-crime policies in the 1980s and 1990s has resulted in a graying of the U.S. prison population, leading to swelling medical costs that states are now struggling to address. As reported in the New York Times, the number of people aged 55 or older in state prisons increased by 400 percent between 1993 and 2013. That group will make up one-third of the nation’s prison population by 2030. Since 1976, the Supreme Court has considered the denial of health care to sick prisoners a violation of the 8th Amendment, regardless of whether they are serving six months or condemned to death row. 

In North Carolina, too, around 17 percent of state prisoners are over 55. Those older people already cost the state four times what it spends on younger individuals, according to research published in the National Library of Medicine. 

Sandra Hardee, Secretary of NC-CURE, helped push lawmakers to expand North Carolina’s medical release law in 2023, lobbying alongside other groups like the North Carolina Justice Center and Conservatives for Criminal Justice Reform.

Hardee said the money that lawmakers envisioned saving in the long run by expanding medical release was key to them approving the new measures. “Before the new law passed,” Hardee said, “Health care for some inmates was costing $1 million a year.” 

According to reports from the North Carolina Department of Adult Correction (DAC), the number of people prisons have referred for medical release has dropped significantly in recent years. In 2021, prisons referred 39 cases to the parole commission, which ultimately granted medical release for 29 people. In 2022, prisons only referred 10 people to the parole commission, which granted medical release to just seven people. In 2023, prisons referred only eight people to the parole commission; three were granted medical and one person was denied, while four others died in prison awaiting a decision. 

DAC has yet to release its report covering the first year of expanded eligibility.

Although Hardee is pleased lawmakers expanded who is eligible for medical release, she says there are still barriers to actually releasing terminally ill people who qualify.

As it stands, no individual or board is tasked with identifying eligible prisoners for medical release, meaning people must find a way to apply on their own. If their family cannot afford legal counsel or don’t have other outside help, the prisoner must handwrite the paperwork themselves. Some prisoners may be too sick to physically file a request on their own.

“Right now, there are about 1,000 people that could be qualified by age and crime,” Hardee said. “If they were released, it would be a step in the right direction, but there is no way to identify them.”

Yvette Garcia Missri, executive director of the Wilson Center for Science and Justice at Duke University’s law school, helped lead the coalition lobbying for the 2023 changes to medical release. Even with expanded eligibility, Garcia Missri says that doesn’t mean all people who qualify are granted release. She said prison officials have seemed to focus on releasing “terminally ill” people, but not those who fit other categories such as “geriatric or permanently ill.” 

“One of our goals is finding ways we can work with DAC to get full usage of the law so that everyone is included,” Garcia Missri said. Part of this goal means defining key terms within the law, such as “medically incapacitated.” “Currently this term is left for DAC interpretation, which could be exclusionary,” Garcia Missri said. If people are not considered medically incapacitated beyond survival, they may not be released early. She hopes that offering clear definitions of the law’s requirements will make it less limiting, reducing the number of people excluded.

Aside from the challenges of seeking release, the new law will only benefit a fraction of the prison population. Its limitations exclude younger prisoners, even those with enormous medical needs.

In 2015, 22-year-old Michael Helms was diagnosed with Crohn’s disease, a chronic inflammation of the gastrointestinal tract that causes intense cramping and diarrhea. Convicted as a teenager, Helms was a few years into a 28-year sentence for second-degree murder and conspiracy to commit murder.

“[Crohn’s] is not harmless,” Helms said while sitting in the yard at Nash Correctional, a medium-custody prison in Nashville, North Carolina. “I’m lucky they put me on the right meds. If not, bacteria could have escaped my intestine to cause sepsis.”

This year, Fox News labeled sepsis a top killer behind heart disease and cancer, taking the lives of “350,000 American adults each year.” 

Helms is too young, and, by the standards of the new law, still too healthy and his murder conviction too serious to make him eligible for medical release.

For treatment, prison nurses administer Helms one shot of Humira bi-weekly, but it’s not cheap. At nearly $4,000 a month, Helms’ treatment has already cost taxpayers about $600,000 since his diagnosis nine years ago. His treatment will cost another $720,000 before his projected release in 2040, totaling $1.3 million throughout his incarceration. That figure is added to the $133 it costs to incarcerate one person per day in the state, as noted by the DAC.

Now 31, Helms is healthy and focused on positive personal change. If he had been convicted 30 years ago, his clean prison record would have helped him earn parole so he could eventually get out and help pay his own medical bills. But North Carolina eliminated parole in 1994 by implementing the Structured Sentencing Act, a sentencing structure that imposes an 85 percent mandatory minimum on all active prison sentences. 

A report published on JSTOR credits mandatory minimum sentencing as responsible for a spike in the national prison population. Earlier this year, the North Carolina Sentencing and Policy Advisory Commission projected that, on average, people imprisoned under the Structured Sentencing Act “will serve 104% of their minimum active sentences,” keeping prisons full of people who will cost more to care for as they age.

James Davis wasn’t sentenced to die in prison. He has a release date. If he were younger and healthier, he’d most likely live to 2039, when he’s eligible for release. Or if the judge had sentenced him concurrently, meaning his sentences would run together and not consecutively, he would be released in 2025 after finishing his longest sentence. Instead, Davis must remain in prison until he dies.

Although Davis is dying from cancer, he knows that he is ineligible for medical release. He won’t sue the state to challenge the new law’s exclusionary rules. His own guilt is partly the reason.

“Two people died, you know, and it’s my fault,” he said, slouching over his walker. “I been here 16 years. I lost my dad, my wife, my brother; I lost a lot of people I loved, so I understand the pain I caused,” he said, lowering his head in thought. When he raised it again, his old eyes glistened with tears. “I wish I had died in the accident. Not them.”