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When Massachusetts lawmakers approved a program to release prisoners who are incapacitated or terminally ill, proponents hailed it as a compassionate, practical measure that could save taxpayers millions in health care costs.

But only four inmates have received medical parole since it was enacted in April 2018 and advocates say prison officials are undercutting the law by preventing inmates from even applying, placing one administrative barrier after another in their path. And they fear proposed regulations will make the problem worse.

As of May 1, the latest numbers available, the Department of Correction had received 22 applications for medical parole, department spokeswoman, Cara Savelli said. Seven petitions were rejected, two inmates died soon after they applied, and the other applications are still pending, according to Savelli.

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“They’re doing more than thumbing their nose” at the new law, said Ruth Greenberg, a lawyer who represents Joseph Buckman, a 73-year-old who is seeking medical parole. “They’re repealing the statute and they’re spitting on the Legislature and spitting on the governor, who signed the statute.”

Buckman is one of two inmates, both serving life sentences for murder, who have sued the state Department of Correction over its medical parole regulations, saying the process is too cumbersome.

Under state law, prison officials must provide inmates a medical parole plan and a diagnosis from a physician, according to the lawsuit. But prison officials have shifted those responsibilities to inmates, the lawsuit alleges. Once an application is filed, prison officials can return it for minor administrative reasons, such as lacking a notarized signature from a doctor, Greenberg said.

“The burden is wrongly placed on the sick or dying inmate,” the lawsuit states.

Savelli said she couldnot comment on the allegations in the lawsuit, which is now before the Supreme Judicial Court.

The four people who have received medical parole, also known as compassionate release, were released from medium-security facilities.

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“I certainly am hopeful that many more people will be released under this program than have been released so far,” said state Senator Will Brownsberger, a Belmont Democrat and one of the authors of last year’s criminal justice bill, which permitted medical parole. “We shouldn’t be warehousing people who are no longer physically capable of posing a threat to society, and instead should be getting them out to a nursing home or hospice where they can get better care at lower cost to the state.”

Prison officials are now proposing new guidelines for medical parole petitions, prompting some legislators to express concern that the process will become more difficult.

State Senator Patricia D. Jehlen, a Somerville Democrat who helped write the medical parole statute, said the revised rules would require prisoners to have a “debilitating condition” to apply — a stricter standard than the one in place now. In the same vein, prison officials would assess whether an inmate is physically able to commit a crime, rather than whether an inmate is likely to break the law, she said.

“It would mean that no one who was conscious could be qualified,” Jehlen said.

In a recent letter to Thomas Turco, the state’s public safety secretary, a group of state senators wrote that the proposed regulations “will negatively impact the application and availability of this important program.”

Mary Price, the general counsel for Families Against Mandatory Minimums, a national advocacy group, praised the state’s medical parole law as “one of the most forward-looking of the recent reforms,” but said the prison system should identify prisoners who may be eligible for medical parole.

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“Instead of placing a barrier to release, the Department of Correction can lend a hand,” she wrote July 8 in testimony on the proposed regulations.

A Department of Correction spokesman said the proposed regulations seek to “ensure the consistent administration of the medical parole statute through the application of uniform terms and processes.”

The regulations are scheduled to take effect July 26 if certified by the secretary of state’s office, said Felix Browne, a spokesman for the state’s Executive Office of Public Safety and Security.

The Legislature for years spurned calls for medical parole, wary that released inmates would commit crimes. But the case of Sal DiMasi, the former House speaker who battled cancer while serving a federal prison sentence for political corruption, galvanized support.

Nationally, the number of inmates older than 55 has increased fivefold over the past 20 years, and all but a few states have medical parole programs, according to the National Conference of State Legislatures.

In Massachusetts, the percentage of inmates older than 55 has increased steadily in recent years, from just over 10 percent in 2010 to more than 17 percent in 2018.

Many medical parole programs, however, have tight eligibility policies that exclude those convicted of the most serious offenses and those not already eligible for parole, specialists said.

“The impact of these policies remains limited because so many people are ineligible, the criteria for release are so restrictive, and the process for approval is so burdensome,” a 2017 study by the Vera Institute of Justice found.

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In Massachusetts, inmates seeking medical parole must present a notarized medical diagnosis and a treatment plan. The prison superintendent has 21 days to review the petition and make a recommendation to the Department of Correction commissioner, Carol A. Mici.

At a hearing, victims’ relatives have a chance to tell Mici whether they want the inmate to have a chance at medical parole. District attorneys can argue for keeping the inmate in prison. The hearings are closed to the public.

Buckman, one of the inmates suing the state, has kidney disease and a seizure disorder and is not expected to live beyond the next 18 months. He was convicted of 1998 of murdering his wife, Susan, in their Randolph home. At a medical parole hearing for Buckman in May, Susan Buckman’s niece, Amy Lassman, said she worried his release would cause her mother more stress.

”Each time Mr. Buckman’s lawyers file an appeal or employ the latest loophole in an attempt to escape punishment for his crime, our mother is forced back in the cycle of waiting and worrying,” she said, according to a transcript.


Maria Cramer of the Globe staff contributed to this report. Gal Tziperman Lotan can be reached at gal.lotan@ globe.com.