Medically Recommended Intensive Supervision: An Overview

In the fiscal year 2019, 2,900 inmates were screened for Medically Recommended Intensive Supervision (MRIS). The MRIS and parole board considered 200 and granted 80.

To be approved for MRIS, the individual must have a severe illness for which care cannot be effectively provided at the prison. Although there are supervision and reporting requirements attached, it is also a form of compassionate release. 

Of the 80 inmates released in 2019, 62 were released on MRIS based on terminal illness. The remainder required long-term care. 

Defining MRIS

Medically Recommended Intensive Supervision provides specific categories of inmates for early parole based on a medical condition. The program identifies inmates in the Texas Department of Criminal Justice (TDCJ) who can be diverted from incarceration to a more appropriate and cost-effective treatment alternative. 

Government Code section 508.146 established the program and contains all the requirements for its use. The Texas Correctional Office identifies inmates on Offenders with Medical or Mental Impairments (TCOOMMI).

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Who Is Eligible?

Eligibility is based on age, type of illness, and the crime for which the inmate was convicted. Several other factors also apply. 

If the inmate has been sentenced to death or life without parole, they are not eligible for MRIS. Also, inmates under active Immigration and Customs Enforcement detention who are not US citizens or have certain reportable convictions or adjudications do not qualify for MRIS.

Inmates convicted of serious and violent offenses listed in the Code of Criminal Procedure 42A.054 or of sex offenses listed in the state’s sex offender registry may only be considered for MRIS if they are terminally ill or have a medical condition requiring long-term care. 

Sex offenders must meet additional requirements — they must be in a vegetative state or have organic brain syndrome with significant to total mobility impairment.

In general, the following are eligible for MRIS:

• Those over the age of 65
• Those who are terminally ill, meaning they must have an incurable condition and a life expectancy of fewer than six months, regardless of life-sustaining treatments
• Those with a mental illness or intellectual disability
• Those with physical disabilities or conditions requiring long-term care

MRIS released for physical conditions or the need for long-term care include several factors:

• The condition is likely to continue indefinitely
• There are substantial limitations in three or more areas of life activity
• The limitations reflect an inmate’s requirement for a combination and sequence of interdisciplinary or generic care, treatment, or other healthcare services of extended or lifelong duration that must be individually planned and coordinated
• Whether the inmate is in a persistent vegetative state or is a special needs patient who requires regular care

Substantial limitations in life activity include self-care, learning, self-direction, mobility, receptive and expressive language, capacity for independent living, and economic self-sufficiency. In other words, the inmate cannot take care of him or herself or participate in everyday activities. 

A persistent vegetative state means an individual experiences profound non-responsiveness when in a wakeful state due to brain damage and characterized by a non-functioning cerebral cortex, the absence of a response to the external environment, akinesia (inability to feel sensation), mutism (inability to speak), and the inability to signal.

When Must an Inmate Be Referred to the MRIS Program?

MRIS staff is required to refer all patients with organic brain syndrome with extreme mobility impairment and all patients who meet the criteria for Hospice or Permanent Infirmary status.

If an inmate requires 24-hour licensed nursing care, is terminally ill with six months or less to live, or with significant cognitive impairment, the MRIS staff must refer them to the program. 

If a patient has active HIV infections that has progressed to AIDS, or if they have a CD4 less than 50, the staff must refer them for MRIS. The same applies to patients with End-Stage Liver Disease (ESLD) with a MELD score of 22 or less.

The Role of the Parole Board in MRIS Decisions

The law requires the Parole Board panel to determine whether or not the individual referred to MRIS is a threat to public safety. It also requires anyone released under the program to have a plan ensuring the appropriate supervision.

Each MRIS referral must remain under the care of a physician and have a medically suitable placement as a condition of release. The panel also requires periodic reporting on the individual’s medical status, and it can modify conditions of release. However, the panel may not revoke release unless the parolee violates one of the conditions of MRIS.

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The MRIS Process

The process for procuring Medically Required Intensive Supervision has two steps.

In the first step, a physician, physician’s assistant, nurse practitioner, or mental health provider (such as a licensed psychiatrist) must complete an MRIS medical summary for the staff or confirm the individual’s diagnosis meets eligibility requirements.

Step two requires the parole panel to vote for release from prison. The vote is also in two parts. First, the board must vote on whether to consider the MRIS request. If the vote is to deny consideration, the MRIS referral ends there. The inmate would require a new MRIS medical summary stating the significant worsening of the inmate’s medical condition. The inmate may also be referred again six months after the panel’s denial.

If the panel votes to consider the request, it must consider the case itself. At this time, the panel decides whether or not to approve or deny the inmate’s release. 

The panel must try to decide within ten business days of receiving the MRIS referral for terminally ill individuals. If the panel denies the MRIS, the process ends, and the staff closes the referral. If the panel votes to approve the release, the MRIS staff must initiate release planning.

Notice of decision is by written notification provided to the inmate, the referral source if other than the inmate, the CID Unit medical staff, Victim Services, and the Parole Division.

In Conclusion…

The Medically Recommended Intensive Supervision program is a method of early release from prison (parole) for those with specific health conditions that the prison system cannot adequately or cost-effectively address. 

In most cases, the inmate is not in any condition to be a danger to the public and, often, may not live more than six months after release. 

MRIS also applies to those who cannot care for themselves and require intensive medical care as a form of compassionate release. At every step, the inmate must meet specific criteria, and the referral can be denied at multiple points in the process. 

If you or a loved one is in prison who may be eligible for Medically Recommended Intensive Supervision, allow the Office of Greg Tsioros to help. It’s difficult enough to be imprisoned and in severely poor health. You don’t need to go through this process alone. An experienced attorney can streamline the process and support you through this difficult time.