While many Americans with brain cancer may be largely left to fend for themselves financially in the face of million-dollar treatments, the $1.4 million in medical costs that convicted murderer and former Manson follower Susan Atkins has incurred since March is a cost entirely covered by the state of California.
It's a situation that may leave many wondering what kind of medical care prisoners should receive and whether taxpayers should be stuck with the bill.
Last week, the California Board of Parole denied a request for a court hearing for Atkins' release from prison. Atkins, who has a brain tumor, is paralyzed on the right side of her body and has had a leg amputated.
The debate over her release has spurred the question: Does arguably the nation's second most famous brain cancer sufferer -- behind Sen. Edward Kennedy -- also receive the second-best care in the nation?
"I dare say that apart from the president and the members of Congress, the people with the best health care in this country are inmates," said Dr. Joshua Atiba, the medical director and CEO of Newport Oncology and Healthcare, which delivers cancer treatment to inmates in prisons in California.
Atkins gained notoriety for her involvement in the murders of actress Sharon Tate and hairdresser Jay Sebring as a member of the Manson family -- a group led by Charles Manson, who is serving a life sentence for the murders. Atkins has spent the last 37 years in prison.
Messages left on the cell phone and in the office of Atkins' attorney, Eric Lampel, were not returned.
According to Terry Thornton, a public information officer for the California Department of Corrections and Rehabilitation, Atkins has been hospitalized in an unnamed facility since March 18, when she was moved from the California Institution for Women in Corona, Calif. She is in serious condition and her prognosis is poor, but her vital signs are stable.
The practice of moving an inmate from a prison to an outside hospital is common practice when care cannot be provided inside the prison, Thornton said.
Atiba said that in this case it was likely done both because Atkins cannot move to take care of herself and to avoid mistreatment at the hands of other prisoners.
"Other inmates would beat her up," he said. "She requires around-the-clock care."
But he noted that the move to the hospital has undoubtedly increased the cost.
At the hearing last week, it was revealed that Atkins' health costs have reached $1.4 million since March, a cost that is paid for by the state.
Atiba said that much of the cost can be attributed to the $10,000 daily cost of a bed in the intensive care unit, along with the money needed for guards. According to Thornton, two guards are with Atkins at all time to prevent family members from helping her escape and to keep her from being harmed by members of the public.
Atiba said that he has never been personally criticized for his work in prisons because by treating inmates in prisons he is able to cuts costs by up to 80 percent.
While all of Atkins' health-care costs are paid for by the state, she cannot receive any experimental treatments while in custody, says Atiba. As a prisoner, she cannot give consent.
"They have no autonomy," he said.
Brain cancer patients in the general public, on the other hand, may have the option to receive such experimental treatments.
High Costs for the General Public
According to the UCLA Hospital System, the total medical bill for a person in the general population who had a diagnosis of brain cancer would be $2.2 million over the same time period.
While a patient without insurance would enjoy a 30 percent discount and consideration for outside financial assistance, noted Roxanne Moster, director of UCLA Health Sciences Media Relations, patients are still faced with a hefty charge.
Better Care Behind Bars?
Not everyone agrees with Atiba that apart from the president and Congress, the best care is found behind bars.
While acknowledging that some inmates may receive excellent oncology care, the notion that inmates receive better health care is disputed by Arthur Caplan, the chair of the department of medical ethics at the University of Pennsylvania.
"We don't have an easy way to get good quality care into any prison," he said. "You can get care, and sometimes it's not bad.
"They're fine if you have a broken leg; they may not be so good if you have psychiatric problems."
Caplan also noted that while many speculate that some people will commit crimes to get better health care, he hasn't seen any evidence that this is the case.
"People are interested in health care, but they're not interested in getting it as a prisoner," he said.
Unlike Dickensian scenarios, he added, "We won't see people committing felonies so they can get into the poorhouse so they can eat."
And even in California, the health care in prisons hasn't always been that good. In 2006, a number of inmate lawsuits over poor health care led the federal government to take control of the health care in the state's prisons.
Still, Caplan said that people are likely to be calling for limits on what kind of health care prisoners can receive in the near future.
"It's going to become a political issue," he said.
Caplan predicts the problems we now confront about prisoners may eventually become discussed more widely as health care costs rise.
"We have a hard time saying no, even with prisoners," he said, noting that the questions applied to them will become more widespread with time.
"Why are we doing things that are basically hopeless when they cost a lot of money? We don't spend much on prevention, but boy, do we spend money to rescue people."