House Standing Committee on Public Safety

Good morning. Convening the Committee on Public Safety.

Today is Monday, October 6th 2020, 5:10 a.m. we are here in Conference Room 325 at the State Capitol for an informational briefing on educating the community about best practices for medical release programs adopted by correctional systems throughout the United States and the extent to which these best practices have been adopted in Hawaii.

Today we have a presenter from Families for Justice Reform, Equal Justice Works fellow Molly Crane, as well as Christin Johnson, Oversight Coordinator for the Hawaii Correctional System Oversight Commission. Here to the Members of the public, welcome to and thank you for joining us.

This is an informational briefing, so no public testimony will be accepted, but the recording will be provided for all of the public to see later at the House YouTube channel, as well as for our Committee Members who are out doing lots of things in the community right now.

In addition, any PowerPoint presentation that was going to be provided will also be provided on the Committee website so that all of this great information that the Committee is getting will be shared widely and broadly. I, I want to give my colleague to my right an opportunity for him to introduce himself.

Well, hi, Representative Garner Shimizu,

And where do you represent?

I represent District 32, Moanalua, Red Hill, Halawa, Lower Aiea, Pearl Ridge, Aloha Stadium, Foster Village.

And Representative Shimizu has a distinction of having one of the larger facilities in his community. So this is an important kind of area topic for all of us in the correctional system. With that, I'm going to turn it over to Kristin and Molly if you want to make some introductions, Christin, and we'll proceed with the briefing.

Yes, Aloha Chair and Rep. Shimizu, thank you both so much for being here today and allowing us this opportunity. My name is Christin Johnson. I'm the Oversight Coordinator of the Hawai'I Correctional System Oversight Commission, and I'm not presenting anything today. I'm really just here to welcome my colleague Molly Crane from FAM.

We're so delighted to have her visiting from Chicago today. And I just wanted to note that a lot of the information that she's going through has been really enlightening for us and for different stakeholders across the state.

Although the Commission did not write compassionate release legislation, and this is not our bill that we'll be talking about later in the presentation today. The bill was written by a community member who's here, Bob Merce, who's been a champion on this effort.

I do want to note, though, that this, this legislation is supported heavily by the Commission and also by the Department and the Hawaii Polling Authority who have had very heavy involvement in helping us write and. And just make sure that it's right for this state. So with that said, I just wanted to introduce Molly.

I so grateful and appreciative for her being here today. I will be available afterwards for questions. And I also want to note that Corey Rinke is in the audience today. Today he's with the Hawaii Paroling Authority. He's the administrator. And so he'll also be available for questions at the end, if anybody had any. Thank you so much. Molly.

Good morning. Can you hear me okay? Yes. Okay. Mahalo. Thank you so much for welcoming us here to share today about compassionate release in Hawaii. My name is Molly Crane and I'm from FAM I feel so humbled and grateful to be here. Thank you so much to Chair Belatti for the opportunity to speak.

Thank you as well to the agency staff who are here today, as well as community members, including those who have been granted compassionate release, and family members of people who need compassionate release. I honor each of you. Thank you. All right, who is FAM, or Families for Justice?

We are a nonprofit and nonpartisan organization and we've existed for nearly 35 years. We work to elevate the voices of people impacted by the justice system and policy reform. We have over 75,000 members across the country, including community members here in Hawaii.

We work to create a more fair and effective justice system that respects individual accountability and dignity while keeping our communities safe. We focus on research and best practices and legislation and close agency partnerships at all levels of government, with a particular emphasis on compassionate release. How did we get here?

We are so grateful that we heard from the Native Hawaiian Legal Corporation, who worked on the compassionate release case for Delbert Wakina Kona, about the barriers to compassionate release and the many people who are in prison with critical illnesses who need help finding their way home.

We also heard from the public defenders, many of whose clients die in custody. We heard from Waikiki Health, who tries to provide re entry support but faces so many challenges that very few people are actually released.

In partnership with law students from the University of Hawaii at Manoa, we built a coalition of community groups to focus on compassionate release in Hawaii. We are here to take the lead from all of you to elevate the wonderful work you're already doing and to offer support however we can.

This compassionate release effort is in partnership with the Department of Corrections and Rehabilitation, the Hawaii Paroling Authority, and the Hawaii Correctional System Oversight Commission. These agencies have been our direct collaborators from the very beginning, sharing their expertise and their time to help us identify barriers to compassionate release as well as joint interagency solutions to those barriers.

And we are so grateful to these agencies for their support in this effort. So what is compassionate release? I've been using that word a lot. Compassionate, or medical release, describes programs created by lawmakers that allow people to be considered for release for medical reasons.

These programs are uniquely important when people are too ill or cognitively impaired to even be aware of punishment. They are too sick to participate in rehabilitation, or they're too functionally compromised to pose a risk to public safety. Why does compassionate release matter? It's important for the Legislature, for state agencies, for taxpayers, and for the community.

Because the small population who would be eligible are the most burdensome and expensive to incarcerate and the least likely to reoffend people. So those who would be eligible for compassion release are the least likely to recidivate. Research first tells us that people age out of crime. We're now about 50 years after the start of mass incarceration.

And that means that the prison populations around the country are graying, including here in Hawaii.

On top of the sort of downward trend we see of recidivism with age, People eligible for compassion at least, are often physically or cognitively incapacitated, unable to move their arms and legs, unable to feed themselves, and even unaware of who they are and where they are. For example, there was one gentleman incarcerated at Halawa with advanced dementia.

When asked why he was there, he said that he wasn't sure. He said he believed his son had dropped him off there, and he was just waiting day after day for his son to come and pick him up. Because of barriers to compassion, at least, he did die in prison.

Unfortunately, we know that the overall recidivism rate here in Hawaii is 54%. However, for people who are sick and elderly or incapacitated in their own bodies, this number drops to as low as less than 1%. There's limited to no public safety purpose met by continued incarceration of these folks.

This population who does not pose a public safety risk is also the most burdensome to incarcerate. We know that a very small number of people take a disproportionate amount of DCR staff capacity and facility resources because of their acute medical needs and incapacitation.

We had the opportunity to speak directly with Department medical staff and learned about some of the burdens that they face. This includes daily care, such as administering medical treatments, but also not strictly medical care. Things like changing diapers and spoon feeding and cleaning up vomit when medical providers are already stretched very thin.

Providing this basic ambulatory care takes them away from operating at the level of their medical license, while other patients in custody really need that. I had the privilege of visiting Halawa twice last week. And the medical unit and infirmary there are truly bursting at the seams with all the sick and dying people.

In fact, there are so many people that are so sick that there aren't enough cells in the infirmary. And very sick people are just waiting for space. In General population where they don't have access to 24/7 nursing care. There is one single hospice room, only one, because the infirmary is full of people who are dying.

That space is also not available to people who may need temporary care, like after an injury or with a transmittable infection. Patients who are critically ill also often need acute care that is beyond the level the facility can provide.

So this means that they may need a lot of external appointments off site, requiring coordination from medical staff and supervision from correctional staff. When we spoke with DCR's team, we learned that this tiny population of people can take up to 90% of their time and resources in the day.

The burden of providing care for people who don't pose the public safety risk, but who nonetheless are very resource intensive, takes a toll on staff. When the vacancy rate is nearly 30%, it is no surprise that staff are struggling with the on and off site care that people who are critically ill need.

In fact, the deteriorating health of people who are dying in prison is actually harming staff health as well. Surveys found that over 60% of staff developed a serious health condition due to job stress. Further, providing this supervision for people who are dying in front of your eyes takes an emotional toll.

Over 75% of staff said that they felt emotionally drained. It's also very expensive to take care of people who have severe medical needs. We know that the average cost of incarceration here in Hawaii is is over $100,000 per person per year. This is a very high price point, particularly compared to other jurisdictions.

However, there are additional costs for people who are critically ill, both at the facility and outside of it. This includes very expensive prescriptions, medical staff having to spend disproportionate time and resources on this group in their care, but also because, as we talked about, critical illnesses often require specializations beyond what the staff are trained in.

The appointments have to happen off site and each of those appointments is an additional cost. Corrections officers also have to accompany people to external appointments and sit at their bedside in the hospital 24/7 often requiring overtime pay. Medical equipment is another additional cost. Oxygen tanks, suction pumps, infusion devices, and more are especially costly.

These conditions require regular monitoring, like labs and imaging, and interventions like surgery to reduce people's suffering.

People who are frail and have critical conditions are also often on the verge of an emergency, particularly when their care needs exceed what the facility can provide, which means that there are a lot of hospitalizations and even medevac flights to get people the care they need.

All of this means that very sick people cost the State of Hawaii and taxpayers far more. All right, so let's talk about a few examples. So one incarcerated individual this year. Their medical care cost has been over 900,000 just in this year thus far. And the year is not over yet.

Another incarcerated individual's medical care has cost over 2 million in the last quarter, in part because this person did have to be medevaced. An additional individual's single prescription took up more than 90% of the entire department's prescription budget for all people in custody.

This expensive prescription doesn't change the care needs for everyone else in the facility, many of whom will also die without access to their medications like insulin. Yet DCR has to pay for this person's prescription, leaving everyone else in custody at risk.

So we know that this small population for whom there is limited to no public safety purpose of ongoing incarceration, causes a massive strain on the system and our state. But beyond the cost, we know that sick and dying people will benefit from compassionate release.

Native Hawaiians are disproportionately represented among the incarcerated population, and we know that real people will benefit from changes to this system. Just a little bit about why we are involved in compassionate release. We've worked on this issue in research and policy for over 25 years.

I'm really grateful that through this work we've become national experts in compassionate release. We've studied every program in the country at the state and federal level and assisted with strengthening these programs so that they reduce the strain on the carceral system while respecting human dignity.

For example, we worked at the federal level to transform their program from one of the worst in the nation to one of the best. With these decades of experience, we've also seen directly what does and doesn't work in compassionate release. We've seen that play out in real time.

We hope to be supportive to that, to the efforts here to bring Hawaii into alignment with best practices, with a Bill that's uniquely tailored to the context here. Why Hawaii?

We are here at the kind welcome of agencies and nonprofits and staff and families who identified this need in alignment with these stakeholders, we see profound opportunities for partnership and systemic change. In fact, Hawaii is actually the only state in the nation whose compassionate release program is not governed by a statute. So what's currently happening?

Right now, Hawaii only has an agency policy about compassionate release. There's no law. This is a diagram about what the current compassionate release process looks like. As I'm sure you can see, the process is complex, it's burdensome, and it's lengthy for agency staff who are trying to navigate this.

This long process is particularly difficult when compassionate release cases are very time sensitive as people are rapidly deteriorating and approaching death. So we've learned through our conversations with stakeholders that there are some really significant challenges to compassionate release right now.

The first is that even though the DCR Director and the paroling Authority act quickly, once a compassionate relocation compassionate release case reaches them, people who should be identified can sometimes slip through the cracks in that very long process. This means that people who qualify instead languish and even die in prison.

Another thing we've learned is that long term care facilities are often reluctant to accept referrals from people who are coming from prison, even if these people are so sick or near death that they pose little to no threat to public safety. There are real human impacts of these challenges.

As Hawaii prisons continue to age, the compassionate release system also experiences barriers and people are dying in custody. You can see how the numbers are trending upward pretty dramatically even just in the last 20 years.

I would love to just pause to share a few stories of people impacted by these barriers, including incarcerated people and their families, as well as medical and correctional staff. The first story I'd love to share with you is a gentleman named Paul. He was a Vietnam veteran who developed multiple sclerosis while he was incarcerated.

The disease gradually progressed to the point where Paul's muscles atrophied, his feet curled up, he lost control of his bowels and bladder, and he could only move his right arm a few inches. He was unable to even hold a telephone handset to his ear so he could speak to his his only daughter when she called.

He had a urinary catheter and diapers and he had to be turned frequently so he could prevent bed sores. He was a full time resident of the infirmary and when the staff changed his bedding, they had to raise him up on a sling while the fresh bedding was put on.

He had to be Fed by hand by staff and sponge bathed. He often choked on his food and he couldn't even wipe his noes as it dripped. His diapers had to be changed regularly.

I'm sure you can imagine just how time intensive his care was for medical staff and also how difficult it was for them to see his condition.

You can also imagine how scary it was for his daughter to know of his decline and to be unable to help while he was incarcerated because of the barriers in the process that we have now. It took over a year for Paul to be granted compassionate release and.

And by the time he was home, he was barely alive enough to see his daughter's face again. The second story I'd love to share with you is a woman named Maria who is a native Hawaiian who had kidney failure because of diabetes.

Both of her legs had been amputated below the knee and she needed dialysis three times a week. This meant that three correctional officers had to take her to dialysis outside of the facility, spending time driving to and from, waiting with her for three to four hours each time for dialysis to be completed.

This took these COs away from their important duties at the facility and leaving other correctional staff short staffed and increasing staff stress. The third story is one that I saw firsthand when I visited Halawa on Monday. Last week, I saw a gentleman who was laying in the only hospice room in the facility.

His temples were concave because of his complete detection deterioration.

The lone hospice room is on the psych wing where people were yelling and banging on their cells, which was hardly a peaceful place for this gentleman's final breaths, even though he had family to support him and medical staff did everything in their power to try to move him through the process.

By the time I got to Halawa again on Wednesday, he had passed. We've been in touch with his family and medical staff and they've shared that they hope that this effort can in some small way honor his life and prevent this from happening to someone else again.

All right, so as a coalition and as an organization, we hope that we can be helpful in collaboration with you all to craft a system that supports public safety and human dignity while unburdening the state.

We're grateful that we've worked closely with agency partners including DCR, HPA, HMSA, Med Quest and the Oversight Commission to better understand the barriers each of these agencies face face. We visited Halawa to hear directly from incarcerated people who are dying. And we're also grateful to have worked with agency partners to develop compassionate release legislation.

And I look forward to sharing a little bit more about this. We are also here to support the implementation of this system, both now and when. I hope the bill is implemented.

We recruited and trained pro bono lawyers to work alongside people who are sick and dying to gather all the information that the polling authority needs to exercise their discretion in these cases, as well as to assist with the Medicaid application process.

Because we met with our agency partners who shared the challenges they faced securing placement, we also got a group of social workers together to contact all of the Medicaid approved nursing homes and we've identified placements that are willing to accept people who have been granted compassion or lease.

We've also already begun receiving referrals of people who need this support with your kind welcome here. We are here for the long haul to implement a system that works with everyone's thought and care that you are trying to build. So the bill.

We are so grateful to DCR, HPA and the Commission who have been partners from the very beginning in drafting a bill that will eliminate roadblocks to compassionate release and stop Hawaii from being the last state without a compassionate release statute. With the input from these partners. Without the input of these partners, this bill would not exist.

And we're so grateful for their collaboration in this process and their support of this bill.

The bill will help in a lot of different ways, including streamlining the process, creating deadlines to make sure that the system moves as quickly as people are deteriorating, providing for ongoing parole supervision for people who have been granted, and collecting data to make sure that the system operates as designed.

We're grateful to those of you we've had the opportunity to speak with already about the Bill, and we look forward to working together to make sure compassionate releases becomes real here. In case it's helpful or you have more questions about compassionate release. We do have additional resources.

We have a toolkit and we have a report that summarizes compassionate release across the country. But I'm here and available for any questions that you all have. Thank you so much for your time.

Thank you, Molly. Thank you, Ms. Crane, for presenting. I want to acknowledge that we have Representative Kim Koko Iwamoto, Vice Chair of the Committee on Zoom. This is our first time that we've been able to host the informational briefing with Zoom.

So we want to thank the legislative leadership for allowing us to do this and we hope we can do more of this in the future. I want to open up to questions first to my colleagues, so either Representative Shimizu or Representative Iwamoto.

I have a question, please. You presented information that the recidivism rate is less than 1% for these populations that we're talking about. What is the reference or how did you get that?

Yes, that comes from the Vera Institute of Justice, and I'm happy to send you the report. It's also been studied in the Unger vs Maryland case. Happy to send that along as well.

And Rep. Iwamoto, did you have any questions? She's going in and out, so I don't think so.

Okay. I don't know how to unmute myself. You're unmuted. You are unmuted. Perfect. Thank you. Thank you so much for your presentation. One of the questions I had was, so it's clear.

So even though the agency, the Department has their own internal policy, what you've described anecdotally, it doesn't seem like it's working as well as the model legislation that we'd like to try to pass here in Hawaii. Do you think there would be this would. How do you think the legislation for us to codify it in the statute?

How would this help the administrators of the agency? How would it take off some of the, I guess, extra steps of their internal policy? How would it streamline it?

Great question. Thank you so much for that. One of the main things that this bill does is it removes a lot of the additional steps. So the process, instead of going through the many, many, many layers, as you'll see here, goes directly from the medical Director to the Director to the Hawaii Paroling Authority.

And that whole process, from a petition being requested all the way to a hearing being held, takes about 30 business days in the bill, as opposed to years, which is sometimes how it's working now.

Right. Okay. Thank you so much. And Chair, may I ask another or make another comment?

Go ahead. Go ahead. Representative Iwamoto.

Thank you. For those of us who've actually been with a dying family member and witness their incapacitation and their helplessness, and I think there's so many residents across Hawaii who, even though they may feel like we need to be a part crime, I feel like people actually understand that that point has been made.

And now that this person's reached this point of inability to care for themselves at all, let alone, you know, become a nuisance to the public in terms of by causing any kind of unsafe condition for the public. I could imagine that a lot of people would this.

And I'm surprised that we are the last state to address this via statute. Chair, do you know if we've actually moved legislation of this type and did it get vetoed or what was the progress we've made on this in the past.

Maybe that's a question for Kristen, but I'll let you, either one of you, take that.

Yeah. Thank you. So compassionate release legislation has been brought up in the past many times. Again, Bob Merce has been the champion of the legislation in the past because Bob Merce has worked directly on cases to help people get out.

I think a part of the issue in the past is that previously the agencies most directly involved in this process weren't actually included in the, you know, bill creation or, you know, or even the revising process.

And so the Department of Corrections and Rehabilitation and the Hawaii Paroling Authority, you know, that was a space where we all recognized, like, they have to be stakeholders from the get go if we want this to be successful. And so I think that's much different than what happened in the past.

It's my understanding that it, that the bill never made it to the governor's office. Okay. Okay, thank you.

To be precise, there was one bill that passed the House and the Senate and was killed in conference Committee over an issue that everybody agreed on, except they killed it on the last day, in the last minute of the Legislature. He introduced another one that just didn't go anywhere.

We introduced one that went and passed the house and the Senate and Governor.

Igay, can you repeat that just so that it gets recorded? Yeah, sorry.

Okay. So there was one attempt where the bill did make it to Governor Ige, but it was vetoed. There was another attempt where the bill had made it to conference Committee and kind of at last minute was removed. And then there was another time frame where it made it through the House.

Yeah, but then I can't remember exactly. Okay, maybe not exact, but it made it through one of the sides and didn't make it past to the other side. And again, I don't think that that was because the bill didn't have merit.

I think the departments who would be most impacted by the spell, like, I think they just needed to be included from the beginning.

Great. Thank you so much for that background. And I do think that given all the federal funding cuts being denied Hawaii, all the funding that's being denied to Hawaii and the economic pressure, it puts our state under any kind of changes we make to be more financially responsible and to not.

Because I know a lot of these costs will be picked up by Medicaid. If we move these individuals out to the public where their Medicaid can kick in, it'll really save the state a lot of money. I think that will maybe make a difference this year. Thank you.

Thank you. Rep Iwamoto. Actually, could you put up the slide, Ms. Crane, for the cost? Because I think that's a very powerful slide. I think the one in particular, $918,000. So this may be more of a question for Ms. Johnson, but this is just to kind of educate the Committee and the public. When we see these numbers.

Can you explain to the Committee and the public how is it that this is a cost burden to the state? And why is that it has to go to the funding sources. And if you can explain that, because of the way that the medical care is funded in the corrections system.

Sure. So when you become a Ward of the state, so when you are under the care and control of the Department of Corrections and Rehabilitation, it is up to the Department of Corrections and Rehabilitation to take care of you all the way across the board.

And so even though it's coming directly from their budget, there's no case in which they can say, well, this is a little too pricey for this. We're not going to pay for it. If you need that care, they're legally obligated to pay for that care to make sure that you're receiving what you would need.

And technically, it should be comparable to what you would get on the outside. The difference is when you're in the Department, it's only the Department who can unfortunately bear those expenses. There's no private insurance, for example, once you're incarcerated, and there's no eligibility for Medicaid or Medicare once you're incarcerated.

So it really is the full cost of the Department and a huge hit to their budget and to the state, of course.

So, and then in Parliament, in terms of, for Committee Members, that means A funds, general funds, cash funds that the state has to pay is what's funding this $918,000 tab and this $2 million tab. These are state funds, A funds.

Correct. And one of the many reasons why this, why this bill and legislation is important is because when you have somebody getting released into the community now they're going to be eligible for Medicare. And so even though it'll still be some of the state paying for that, I know it's a shared cost.

You know, the Federal Government would definitely help and assist with those costs.

In addition, if I may, we also don't have the corrections officers who have to accompany someone and sit at bedside, so there are additional costs savings as well.

Okay.

Now, Ms. Crane, because you come from the, you know, you have the umbrella view of the country, can you speak to how, even though Medicaid is being underfunded in red states in particular, can you speak to the importance of the Medicaid waiver and how that is actually helping states manage better the cost of care for this population?

Absolutely, yeah. So there's a program called the 1115 Waiver, and this allows Medicaid to begin enrolling someone in services 90 days prior to their release, which means that by the day that they are released, all of their care is ready to be paid for. There's no gap in care. They've been connected to providers.

And this is paid for in part by the Federal Government instead of the State of Hawaii.

So if the match for Medicaid is, what 60/40? Is that what it would be in this population?

That's my understanding.

So the $2 million, 60/40 split would be. I don't know, what is 60% of $2 million? It's a substantial savings to the state. Okay. Do you know if the implementation, for.

Example, might not have needed to be medevaced if he was in the community? So being able to access the care that you need in the community setting is always cheaper, even if you don't include corrections officer costs, for example.

Have you seen what the other states are doing with the reentry services waiver, or is it still too early to kind of have understanding of what's happening?

We're already seeing this being implemented. For example, we are working in a number of other states doing exactly this. And people who are eligible for compassionate release are being enrolled and they're being accepted to nursing homes because nursing homes know that they will have Medicaid day one to pay for that person.

Have you folks met with the Medicaid Agency or MedQuest to discuss how we can implement this quicker and more efficiently?

Yes, we've met with them on several occasions, and they are very bought into making this process more efficient for the people who are impacted and also for their agency. So we've already identified a number of ways that their process can be smooth for this unique group of people.

Okay, yeah, go ahead.

Thank you again for presenting and for all of your organization's efforts. It's quite. I don't know, what is the word? Alarming. I guess that Hawaii is the only state that does not have any statute that covers this. So if this law is passed and there is compassionate release, does that inmate.

Are they now free and they become a personal, just a regular person and their. The family is. And the individual is now responsible for their own care, Is that how it Works.

I really appreciate that question. So the process will still go through the paroling authority, who has discretion to go grant or deny release. So it's not the case that anyone who's sick is automatically granted.

If this law goes into effect, the paroling authority still has to examine their case, assess risk to public safety, make sure that they're medically eligible before they consider granting someone. If someone is granted, then they're on parole supervision.

And so the paroling authority is still keeping an eye on that person, making sure that they're following the rules and the parole can be revoked if there's any barriers. Once someone is granted, then they can be in a number of settings.

They could be in our family where Medicaid will help with durable medical equipment and home delivery and hospice care, or they could be in a long term care setting.

So basically it's a personal responsibility versus a state cost. Is that what I'm hearing?

It's partially a state cost in that they're still on Medicaid with the state contributes to, but it is the individual's responsibility. The Department of Corrections is no longer responsible for that person.

Okay, well, thank you. Thank you for that.

I'm trying to understand the barriers in the system. Right? So first, it's not a barrier, but it's just a cost. Can you speak to the barrier of having someone identified as qualifying for medical release, compassionate release, and you had earlier identified that sometimes they fall through the cracks.

I'm looking at DCR's testimony on House Bill 824 from 2023, and it's interesting because in 2020 there were 22 applications. But by 21 and 2022 they had dropped down to five, which I find that concerning because you're right. Everywhere in the community we're seeing the grain, the tsunami, the silver tsunami coming.

So it should be no different internally. What is the barriers for identifying for eligibility?

I welcome Christin to weigh into this as well. But one of the challenges is that right now there's a very limited group of people who can petition for someone to be considered. One thing that this bill does is it opens it up to a lot more people and Christin, her people themselves can ask for consideration.

Someone else who's incarcerated, who sees someone who's very sick, can petition for them. A family member now can. So if they hear that their loved one is sick, they can submit an application. An attorney can do so.

But we're also working closely with the medical Director to make sure that the primary care providers will be briefed on this policy and will be actively identifying people right now.

You know, the medical Director has said that she has 20 people who are in need of compassionate release and actually five people who've already been granted compassionate release who are still in prison because they're awaiting placement. And so the need is certainly there.

Can you speak and elaborate on when family mambers can file? Do you see family members who are staying in contact with their loved ones and then looking for ways so that they can ensure, because they understand that this is the end of care, end of life care?

Yeah, we do see a big difference. You know, it may be that over a long time of incarceration, you might lose touch with your family or there may be prior trauma. But we do see that when people are reaching the end of their lives, family members want to take care of them, want to be supportive.

And in fact, we have a family member who's here today who is looking for ways for her loved one to come home, including through compassionate release.

So family members also can play a part in making sure public safety is ensured and that personal responsibility is respected. Absolutely.

Yes, go ahead.

Question.

Do we have numbers on the number of inmates who die in place because of this? They're not able to get released and they're struggling with the care?

I don't think we have the breakdown.

That specifically, no, because historically this has not been something that has been tracked as far as necessarily the Hawaii Paroling Authority has tracked the cases that come to them. But the cases prior to the Hawaii Paroling Authority, those pieces haven't been tracked. And it also hasn't been tracked where it stops within the system.

So it's difficult for us to say where exactly the block is.

But what we've heard from medical staff in particular is that the way that the current system is set up, there are so many people who it has to make it through, and any of those people can say no before it even reaches the Hawaii Polling Authority, that there may have been somebody who the medical Director was trying to get out a year prior, who, you know, now that they're on their last dying breath, it's a rush for everybody.

But it wasn't when they were initially diagnosed with whatever they had. So the bill is multifaceted in breaking down the barriers. But also there's a very large section about tracking numbers. And this is something that the Hawaii Polling Authority and the Department and the Commission had gone back and forth on, but all came to agreement.

Ultimately, it's important to track these numbers so that moving forward, we understand, you know, who may have been denied before being released, you know, and what all of that can tell. That information can tell us. Yeah, go ahead.

Okay, thank you. I don't want to make it about money because this is about people and obviously compassionate care, but I think it would be a strong selling point. Do we know how much the state would save by implementing this compassionate care?

It's a little bit hard to estimate, but one number that we heard is that, you know, it's about 100,000 per year for, on average, but that for people who are over 50, that number could be as high as 300,000 per year. And there's about 1,000 people in that category.

That doesn't mean that all of them are sick enough to qualify. But if we presume that, you know, even half of those people could be eligible, that's like $150 million per year per person.

Yeah. You're talking about 100 to 300,000 per person. Per person, per year. Thank you.

Okay, so there's the eligibility identifying, there's the housing issue. Can you speak to that? And I know you spoke a little bit about it in your presentation, but what is it about the housing piece that's challenging?

Yeah. Would you like to.

I can, I can speak to it, but I'd love Cory to weigh in if he'd like to. This is an issue we're seeing across the country.

You know, it's sort of a mix of needing to equip loved ones with the supports they need because a family member might be scared about trying to provide acute care for a loved one unless they have, you know, durable medical equipment at the State of hospice care, people who can come and check on them.

So it's supporting families who want to do this. It's giving guidance and education to nursing homes about Medicaid and about accepting people who may have prior convictions, trying to look at someone's present risk as opposed to what someone's conviction might say about them 50 years ago. But this is also particularly true for state run hospitals like Leahi.

This is a real opportunity for us to provide guidance about what they can to be doing and how they can be doing more for this population. Population. It's also building relationships with nursing homes so that they're ready to receive referrals. And this is some of the work that we've been doing.

As I mentioned, there's five people who are still languishing in prison even though they've been granted because they're waiting for placement. And we're grateful that we were able to provide referrals to some of the nursing homes that we've identified.

You have a question?

Yeah. So do you see that there is capacity to receive these released patients?

So if I can. So I think many of these spaces do have capacity. I think the problem is the fear of taking somebody with, you know, a felony or a very serious offense.

I do want to give props to the Hawaii Paroling Authority and Corey, I hope you don't mind me sharing this story, but I know that Corey Rinke individually spoke, spent a full day calling home after home after home after home, just one after the other. Him personally taking that time to try to find placement.

I think the problem is, just as Molly was saying, there's a serious lack of education, especially with the recidivism piece understanding that, yes, 30 plus years ago they may have done X, but they can't run, they can't move their arm. I mean, whatever situation, they're not, they're not a public safety risk at this point.

And again, that's something that polling authority looks at before they even decide to release somebody anyway. But I think the point is there could be capacity. I think there's just some potential fear going on.

And so that's where FAM has been very helpful in at least finding five different placements that Hawaii Polling Authority didn't previously have that are willing to take these folks.

So because I'm a former health Chair and this actually just popped into my head because it's not just the Section 1115 waiver that we have with Medicaid, they actually have an innovative palliative care program.

Did you, were you able to discuss that with a Medicaid med quest at all as to how that might also integrate into making sure that the support services are needed for family members who might be willing to take in their dying relative for the last weeks or months of that person's life.

Yes, I really appreciate that question. We have spoken with them about the sort of various levels of care that someone might need and the different pathways to get there. And so the most challenging pathway is someone who needs long term nursing care placement.

But for someone who needs palliative care, it's a much more streamlined process and they offer a lot of supportive services to family members. And hospice is the shortest path. It's the quickest to get services and the most coverage.

So palliative care here in Hawaii I think is very good. We're leading in the country. And so if we can blend these two programs together, again, cost savings is important, but it's also dignity at the end of life. That's really important to people in Hawaii, I think.

Okay, that is the shortest informational briefing I've ever been a part of, but I don't think I have any other questions. Rep. Iwamoto, do you have any other questions? You're on mute, and I see you talking, and I know you want to say something.

Okay. Am I?

Now you're not.

Now you're talking. Yes, go ahead. Thank you so much. Lastly, a lot of people, as they get older, they have advanced healthcare directives.

And I know that's kind of awkward to ask incarcerated people to fill one out when they come in, but even if somebody fills out an advanced healthcare directive that said, please do not resuscitate me if I have these kinds of illnesses, it's my understanding that the warden cannot honor that because they have a duty to keep somebody alive.

Whereas if somebody is to the point where they're permanently incapacitated and they don't want an intervention by moving them or by doing a compassionate release, then whatever care home they're in and whoever's providing and managing their health care could honor an advanced health care directive in terms of what kind of interventions to.

I mean, because it's almost torturous that we're keeping people alive to suffer, you know, But I think that's currently the status quo. Is that correct?

I don't know if that's the status quo, but I know one story comes to my mind that the healthcare staff had told us there was an individual with very serious brain cancer. And at that point in time, he was trying to express that he didn't want any further treatment, that he wanted to be done.

But unfortunately, he was also determined at the point where he couldn't make those decisions for himself. The family really wanted the care to continue. And so he continued to have portions of his brain removed, which is a very extreme, expensive, obviously, surgery.

And so, you know, I know the Department would know much more about what you're referring to. Rep. Iwamoto I just, I don't want to speak out of turn. I'm not positive on that. But I just.

I do know that there are many cases where, you know, individuals are just to that point where they just can't make those decisions for them, unfortunately. And I think the Department just has to do the best they can to continue care and continue to do what they're legally entitled to do and authorized to do.

Repiwamoto. I think that's a good question. And that might be something that we can follow up on as we continue to understand what this process is that people have to navigate. Because that is a very sticky wicket. It's a very sticky wicket to be dealing with. Again, the shortest informational briefing I've ever been a part of.

But I want to say and acknowledge to the people in this room, I actually thought this was only going to be informational briefing with me and Ms. Crane and Ms. Johnson. It is wonderful to see advocates here. We have people from the Commission. We have people who are from churches, I believe, from community, family members.

And thank you, Mr. Rinkey. I've not met you in person, so thank you for being here. And we also have representatives from the Senate Judiciary Committee. And then I also see legal organizations here in the community in the audience as well.

I think this has uncovered a really important issue and one place where we can be both the stewards, better stewards of the people who are in our custody, care and control, as well as better stewards of precious money, resources that we have that are limited now.

And the freeing up of money can actually help hopefully improve the experience of others within the correctional setting. I'm very concerned that it takes three ACOs. We need ACOs to be on premises.

And when we have to take and remove three ACOs for medical care for someone who really should be out there in the community and being cared in ways that is not so resource intensive would just be better for everybody. So on that note, Representative Shimizu, did you want to make any closing comments or remarks?

And then I'll give the floor to Rep. Iwamoto and then we'll conclude.

Thank you, Chair, for arranging this and thank you, Molly and Christin, for providing such good information. And I would be very happy to sign on this bill. Yeah. Thank you.

And we'll have all of the Public Safety Committee Members have that opportunity. Rep Iwamoto, did you want to make any closing remarks? I think you're pressing the wrong button when you want to talk. And now you're on.

Go ahead. Just to say thank you very much to FAM and Christin. Thank you so much for the leadership on this. And I do look forward to supporting this in any way that I can as well. And thank you, Chair, for holding this briefing.

Thank you. On that note, we will make this, the PowerPoint available. I will also make available on our website the DCR policy that governs this area. And so that will also help us as we move forward with the drafting of legislation. On that note, on this. Happy Monday thank you all for being here. And we are adjourned.