By November 2011, Utilization Management had enjoyed modest success with medical parole. The office had identified some 40 candidates; 27 of those had won approval. None of the parolees had shown medical improvement.

The system seemed to work in balancing medical condition against threat to public safety. The first MP applicant, for example, was Steven Martinez, a 42-year-old rapist made quadriplegic in a prison fight. His medical care cost the state some $625,000 a year; he had been turned down twice for compassionate release. Dr. Barnett says she approved his MP application because he met the medical criterion of permanently medically incapacitated. But I made sure to indicate on my application that he was awake, alert, oriented, high IQ, and capable of planning complex analytical thought, she says. Thats all I needed to write. In May 2011, the parole board denied him on the grounds that he was mentally alert and could carry out threats using others as proxies. ^[26]

Like her medical colleagues, Dr. Barnett does not want to know the criminal record of MP candidates; she did not know Martinezs history until the press described it in covering his MP application. I will presume, and its almost always the case that if I knew about [the crimes], I would be horrified, she observes.

And thats enough for me. I dont need to know whether it was murder, rape, kidnapping, mayhem. I know that this probably wasnt a nice person, and I would probably be appalled if I knew and it would cloud my judgment.

Dr. Ricki Barnett on the criminal records of MP candidates.

At the same time, Dr. Barnett recognized that in many cases [t]he person who committed that crime no longer exists. There is a brain-damaged individual in front of you who no longer has any memory, any ability or any capacity to form intent. Theres nothing inside anymore. Some incidents had only confirmed the need to keep re-accentuating that view. For example, a parole officer had discovered a brain-damaged parolee, with the cognitive abilities of a one-year-old, masturbating. The officer, apparently judging this as a risk to public safety, dispatched the patient to a guarded unit in a community hospital until the Board of Parole Hearings could revisit his medical parole. Comments Dr. Barnett:

The parole officers who guard the patients are still programmed to react to behavior the way they would react to the same behavior in an able-bodied healthy person, with an intact brain and an intact body.

Dr. Bick at CMF believes that such a reaction is a reflection of society, not just the corrections culture. He recognizes that many of his patients have done terrible things. But, he adds, I will say that I think just in the larger sense as a society, prisoners are stigmatized. Behaviors that come from someone whos not a prisoner or a former prisoner might be viewed one way, and someone whos a prisoner, its another way.

Dr. Barnett received Wades medical file in mid-December. ^[27] She knew he had been turned down for compassionate release, but was aware that courts had varying reasons to deny CR. She notes:

The sentencing judges who oversee the compassionate release decision are aware of medical parole and aware that [the state] will front the expenses. They oftentimes decline to give the permanently medically incapacitated people compassionate release, saying Why dont you just apply for medical parole? That way, the county doesnt have to give up its limited funds to support you. The state and the CDCR will pay for it.

Wade was due for ordinary parole on October 3, 2019. Barnett had to decide whether to put him on her list of candidates for medical parole. On the one hand, Wades medical condition was terminal. On the other hand, his date of death was difficult to predict, and for now he was mentally alert. Did he fit the definition of permanently medically incapacitated? Could he re-offend? It was the first year for medical parole, and as Receiver Kelso recognized, mistakes could be costly. Virtually everything were doing is for the first time, he says.

Thats why were paying a lot more attention to it Since its in its first year, were trying to see if we can get it off the ground and not have some terrible thing happen that causes the legislature to kill it.

At $200,000 a year, Wades care was clearly a drain on the public purse. But Dr. Barnett was of two minds. Should she put him on the list, or not? The decision, at first glance straightforward, involved so many considerations. She observes:

On the one hand, you have public safety. On the other hand, you have common sense. You have the state taxpayers versus the county taxpayers. You have custody and medicine. You have the victims and the defense attorneys versus the public advocates. You have use of expensive resources everywhere. What is the best solution for all the stakeholders that creates the least amount of damage and harm?