Patrick Constantino Russo was sentenced to Halawa Correctional Facility for the rest of his life for the heinous crime of shooting and killing two customers in the Sports Page Lounge on Kalakaua Avenue on Jan. 16, 1980.

Thirty-five years later, Russo —now 67 — suffers from multiple sclerosis and has no movement below his neck and requires around-the-clock medical care in Halawa’s infirmary — a life-sentence worth of medical costs paid for by the state Department of Public Safety.

"He’s a functional quadraplegic," said retired lawyer Bob Merce, who does not represent Russo but is working pro bono to find Russo medical care outside the walls of Halawa.

"He’s obviously not a danger to anybody," Merce said. "He can’t even move his arm to feed himself. But we can’t find anyone to take him. It is kind of understandable. What would they say to the families of other patients — ‘Mr. So-and-So next door is a double murderer?’"

Halawa, like state prisons around the country, is working to get patient-prisoners such as Russo released on parole so they can get medical care outside of prison once it’s determined they "are too functionally compromised to pose a significant risk to public safety," according to the state Department of Public Safety.

Until the past few years, corrections officials referred to the practice as "compassionate release," but it’s since been rebranded to the more neutral term of "medical release."

The practice can have emotional implications for the prisoners’ victims and runs counter to the idea that inmates should pay fully for their crimes in the name of justice.

But from a pure budgetary standpoint, medical releases can have profound financial implications for states such as Hawaii, which spends $23 million annually on its prison medical costs.

By releasing prisoners such as Russo on parole to a traditional long-term-care facility, DPS would shift Russo’s lifetime medical expenses off its books and onto federal Medicaid.

But Halawa officials sometimes find themselves stuck with such prisoners, who are declined admission to outside facilities because of their crimes.

"We can’t find anywhere that will take them and they don’t have family that will take them," said Wes Mun, the department’s corrections health care administrator.

The issue of Hawaii’s medical release practice grabbed headlines in November when retired car dealer James Pflueger was released on "extended furlough for medical reasons" from the Kauai Community Correctional Center at the age of 89 after serving just 1 1⁄2months of a seven-month sentence for his part in the Ka Loko Dam break that killed seven people in 2006.

Pflueger was ordered to remain under house arrest for the remainder of his seven-month term, with the provision that he could leave only for medical care or to report to corrections officers.

His release outraged many who characterized it as a privilege granted to a rich businessman. The state attorney general’s office was tasked with notifying the families of the seven victims that Pflueger had been released early for medical reasons.

In the past 21⁄2 years, Merce has helped three Halawa inmates get admitted to long-term-care facilities and has a different take on Pflueger.

"If the Hawaii Paroling Authority determined that he should receive ‘compassionate release,’ I support that decision, and having worked with the parole board, I am confident that it based its decision on medical and legal grounds and that wealth did not enter into its deliberations," Merce said.

Citing patient confidentiality, Mun and DPS spokeswoman Toni Schwartz declined to discuss Pflueger’s case, which occurred under the previous prison administration — or reveal the names of prisoners who could likely be released on parole because of their medical conditions.

Schwartz did say the entire state prison system has only two: a murderer and a sex offender who are both cared for in Halawa’s infirmary.

Merce insisted that DPS actually has three prisoners whose medical conditions would qualify for medical release: Russo, the sex offender, and a murderer with dementia who serves his time in a Halawa cell but has no idea why he’s in prison — or even knows that he’s in prison.

"Those are the ones I know of," Merce said. "There could be more. It makes you wonder how many prisoners have died in prison when they could have been released."

This month, the inspector general for the U.S. Department of Justice released a study on the impact that aging inmates and their rising health care costs have on the Federal Bureau of Prisons and found that inmates 50 and older represent the fastest-growing segment of the federal prison population.

Older inmates are better behaved but "are more costly to incarcerate than their younger counterparts due to increased medical needs," the study concluded.

In fiscal 2013, the inspector general found that the Bureau of Prisons spent an estimated $881 million — or 19 percent of its total budget — to incarcerate older inmates.

For elderly and seriously ill prisoners in Hawaii, "those costs can skyrocket," said sate Sen. Will Espero, vice chairman of the Senate’s Public Safety, Intergovernmental and Military Affairs Committee.

"If an inmate is so ill or has a condition that almost makes that person immobile and not active, and if they’re unlikely to commit another crime — and if it will save dollars — we obviously need to take a close look at that and see if there are ways to accommodate these patients," he said. "We can both accommodate that individual and save taxpayer dollars."

Mun said each case is unique. But Espero, who has concerns about Pflueger’s release, said he hopes prison officials can "be a little more transparent and consistent in making those decisions. The public has to be given minimum information to understand that this person is not a threat to society and the cost to the state would far outweigh not releasing him."

But a prisoner’s criminal history is hard to ignore.

With the convicted sex offender, "there’s a lot of stigma in finding him a place," said Louis Erteschik, executive director of the nonprofit Hawaii Disability Rights Center, which works with Merce. "They’re having particular problems getting him placed so he’s still in prison. There’s a visceral reaction that care home operators have. They don’t want a sex offender living in their house. It’s hard to forget about the offense, but we have to look at this as a larger issue."

"Compassionate release is about aloha for our community," said Kat Brady, coordinator of the volunteer organization Community Alliance On Prisons. "To keep somebody who is just in the poorest physical shape incarcerated when they could receive some respite care is unconscionable. Across the country it’s a huge issue, not just in Hawaii, as our health care costs skyrocket."

Russo, a Vietnam War-era veteran, should be eligible for Veterans Affairs medical care but was denied admission to the Yukio Okutsu State Veterans Home in Hilo.

Steve Gold, regional vice president for the Hawaii region for the Avalon Health Care Group, the parent company that operates the veterans home, said both Russo’s double murders and medical needs were carefully researched before deciding to deny admission.

Administrators looked at various factors, Gold said, and determined that Russo’s medical care exceeded the veterans home’s capabilities and his criminal past could be disruptive — along with the potential that he could become violent.

"Concerns were raised for all those specific areas — the threat of health and safety, criminal history and intense medical needs that would be required," Gold said. "Every one of those factors weighed equally."

Even though he cannot find a facility that will accept Russo, Merce insisted that a national groundswell has begun that will change attitudes toward releasing prisoners such as Russo.

"There’s no reason or need to have these people in prison," Merce said. "People are starting to see the light."