On the other side of the nation, in Pennsylvania, lives Irvin Moore. Now 79, Moore served 52 years for first-degree murder and aggravated robbery before being released in 2021.

“Medical care in prison is horrendous,” Moore said. “At best.”

“I’ve lost so many friends to Stage IV cancers of all different sorts,” he added. “How can a person get to that stage if they’re being examined and checked regularly? I think for the last six or seven years, I may have had a checkup twice, at 75 years old.”

Gonzalez-Rivera described this as an “epidemic of misdiagnosis.” He highlighted an example of one incarcerated person’s stomach pains being treated with an over-the-counter medication like Pepto-Bismol. The pain turned out to be stomach cancer.

“Signifiers of chronic conditions that might be tested for and analyzed in community medical settings are just not flagged in time,” Gonzalez-Rivera said.

Stern, the Washington correctional physician, explained that due to budget constraints, diagnosis and care are often not provided by staff with the required qualifications. Conditions that require treatment from physicians are often left to physician assistants, and roles meant for registered nurses are handed to lower-paid practical nurses with only two years of training.

Colin Creveling, a registered nurse supervisor at Laurel Highlands, a low-security prison in Pennsylvania, believes that these problems stem from a broader crisis in medical staffing nationwide, as well as the stigma of working in prisons.

“The medical field has been battered since Covid,” Creveling said. “The staffing issue is not just in a prison, but anywhere. The issue with prison is, you don’t go to nursing school and think, I’m going to work in a prison.”

When speaking about hospice care behind bars, both Moore and Snook responded with a bitter laugh. “There’s absolutely no hospice care,” Snook said.

“It’s a shame that I would have to even laugh at something like that, because it’s no joke,” Moore said. “Guys lay in bed until they die.”

“It’s what we call DBI,” Moore continued. “Death by incarceration.”

Most states outsource prison healthcare to for-profit contractors, meaning profit shapes every level of care. Since the federal Affordable Care Act protections do not apply to prisons, incarcerated people are not guaranteed regular checkups, prescriptions, or access to doctors.

Ruth Greenberg, a criminal defense lawyer who helped bring medical parole to Massachusetts, said that contractors often start by estimating the cost of an inmate’s needs before treating them. If their care turns out to be more expensive than the estimate, there is no guarantee that the extra cost will be met.

Furthermore, taking an individual to a hospital requires paying for at least two accompanying officers, sometimes with an overnight stay, explained Gonzalez-Rivera. This leads to bigger, more expensive procedures’ being ignored or avoided. Snook’s prostate cancer took 17 months to get treatment.

Another example of cost-cutting is dental care: Removing a tooth is cheaper than a filling, so people are often left with missing teeth. Loretta Pierre—who has been in prison in Mississippi for four decades—once booked an appointment in 1997 and wasn’t seen until 2002.

“All of my teeth are falling apart,” Pierre said. “That’s one of the things that I’m gonna have to take care of whenever I get out of here.”

This lack of basic medical attention leaves individuals with no alternatives for finding or receiving healthcare.

“Who can you complain to?” Moore, the formerly incarcerated man from Pennsylvania, asked. “It’s like policing the police.”

“We are such a punitive country,” said Michele Deitch, director of the Prison and Jail Innovation Lab, a national policy resource center. “We’re really the only country in the world that keeps people locked up so many years. We are getting so used to that here that we forget that that’s not normal and other countries look at us like we’re crazy.”

In 2016, a report from The Sentencing Project found that around 40 percent of incarcerated individuals in the United States—that’s 600,000 people—were imprisoned without any legitimate public safety justification. Moreover, 83 percent of the entire world’s life-without-parole population is behind American bars.

In countries like Finland, Germany, and Norway, prisons promote rehabilitation with shorter sentences. In turn, they see lower rates of recidivism and violence. Experts have suggested that there is no benefit to longer, more punitive sentences.

“They have much more progressive mindsets and systems,” Carole Cafferty, who worked in Massachusetts jails for over 30 years, said of these countries. “They incarcerate people for the sake of rehabilitation and use restorative justice practices. We incarcerate people for the sake of punishment and retribution.”

Greenberg explained that she has had multiple clients who died shortly after their compassionate release applications were denied. “There’s all these really sick people there in wheelchairs, on dialysis four times a week,” she said. “They’re paralyzed from the waist down, they have pancreatic cancer, very sick people, and the commissioner is saying, too dangerous to release.”

For those struggling to understand compassionate release, Cafferty argued that improved victim services could build ground for empathy. She explained that families may then be better equipped to cope with loss, grief, and what Cafferty calls “retributive anger,” where families wish to keep people locked up even when it no longer serves a purpose.

“If victims had more services and help, we would probably get a lot more people paroled, and medically paroled, so they can die with dignity—at home or in a hospice facility—or turn their medical issues around and have a second chance,” Cafferty said.

Shneaqua Purvis’s sister was shot and killed by a stray bullet in 2002. After her sister’s assailant completed a manslaughter sentence and was released, Purvis began mentoring him. She later testified before the New York State Senate in support of the Elder Parole and Fair & Timely Parole bills, which seek to expand parole eligibility and reform parole decision-making.

“Justice to me means that he goes on to help prevent other acts of violence from happening,” she wrote in her testimony.

Luz Marquez Benbow also testified in favor of these bills after being sexually assaulted three times in her life.

“Prisons are inherently violent institutions,” Benbow wrote. “To get at the root of such violence demands that we invest in supporting real accountability, which means fundamentally changing one’s behavior and giving back—not dying in a cage.”

Jonathan Kirkpatrick, who was incarcerated alongside Snook for around 17 years, says Snook is one example of someone who no longer needs to be in prison. “If they let him go, he wouldn’t be a very productive member of society, but not destructive either. He’d just sit with his plants on a porch,” Kirkpatrick said with a laugh.

At Stafford Creek, Snook is holding on. He’s noticed that he needs to write things down now to remember them, so he plays Sudoku to keep his mind sharp. He can’t leave his room without his wheelchair and is constantly in “excruciating pain.” His only treatment, currently, is three Tylenol pills a day.

As we spoke on the phone, Snook sat alone in his cell. He described his door, a little wider than others to fit his wheelchair through. He described his old cell in a different facility. He had 38 plants there.

As of 2021, nearly 16,000 people in prison had spent over half of their lives behind bars. More than 18,000 people had served over 30 years, some incarcerated since 1965. The end of the Vietnam War, the fall of the USSR, the creation of the Internet, and the Covid-19 pandemic have flown by while people like Snook have remained incarcerated.

Yet for 50- to 65-year-olds arrest rates hover around 2 percent. That drops to almost 0 percent for people over 65. Greenberg explained that because of this evidence, personal emotion shouldn’t play a role in compassionate release decisions.

“If somebody killed my husband, my daughter, I’d want them to die in prison too,” Greenberg said. “But that’s a different question, what a person feels and what the state should do.”

Chris Blackwell, an award-winning incarcerated journalist and Nation contributor who spent time in the same facility as Snook, agreed.

“I have never met a single one of those individuals, in their 70s and 80s, that would cause any harm if they were to go home,” Blackwell said. “Most of them would go home and sit in a wheelchair and just be around their family.”

Studies found that incarcerated individuals can change by developing hope, building positive bonds with others, and changing their outlook on life. Many people describe feeling regret, seeing things differently, and becoming calmer, less impulsive versions of their younger selves.

“When I first met Don, we were both not very likable people,” Kirkpatrick said. “But we’ve both grown in different ways.”

People like Snook and Moore were incarcerated in their early 20s. The prefrontal cortex—the brain area responsible for moral reasoning and impulse control—only fully develops by 25. The incidence of violent crime also decreases after 25.

“My younger self—or any other younger prisoner coming in—I would advise they put the blinders on,” said Snook. He spoke of the man he killed in 1977, who he says was a child rapist. “While it stopped that particular person from harming children, others still did. You can’t stop the sickness.”

Snook says he has been on the “low risk to reoffend” list for 14 years, with almost 20 positive behavior observation evaluations.

“There’s so many people in [prison] that deserve a second chance,” Moore said. “They weren’t the same people that they necessarily are today.”

Snook’s story shows what happens when a system is unwilling to acknowledge change.

“You’ll see a lot of the older gentlemen, they’ve been in prison so long that a lot of guys will look up to them,” Blackwell said. “They get guidance from them. Especially the lifers because it’s, like, the one thing they can give, right? Most of them know they’re gonna die in here. They’re always looking for ways to mentor young men.”

Today, Moore is a student at Penn State University, working toward an undergraduate degree in Rehabilitation and Human Services. Pierre still hopes to go to the dentist when she is released. She is currently no closer to finding out when that will be.

“We need leaders, we need people in positions of power and authority to ensure that people are treated justly, people are treated humanely,” Moore said. “Cost cannot be the overriding priority, because if it is, people will be crushed. People will not be considered.”

Snook works as a game porter, keeping track of all the games people in the prison have access to.

While he was in isolation in Walla Walla, most of his friends were sparrows. They’d get caught in the barbed wire of the prison, and he’d clean them up and splint their wings. He made them nests from his T-shirt and fed them pieces of bread.

He named most of the sparrows Chance.

When the sparrows’ wings healed, Snook would take them outside and set them free.