For the last four years, Tom Girardi’s daily life has been organized around his dementia diagnosis.
At an upscale assisted living facility in Seal Beach, members of an around-the-clock nursing staff bathe and dress him, take him to the restroom, make sure he eats, prevent him from wandering away and remind him again and again where he is and why.
On Thursday, Girardi’s status changes from patient to inmate. The 86-year-old disbarred trial attorney, a legal legend who once towered over California’s justice system, becomes inmate 43156-510, one of more than 150,000 people federally incarcerated.
How the prison system will handle Girardi’s cognitive problems during his seven-year sentence for stealing from clients is unclear. In addition to regular prisons and minimum security camps, the U.S. Bureau of Prisons has six medical centers that care for ill inmates. One in Massachusetts operates a small, overburdened dementia unit.
The process of evaluating a new inmate for mental or physical illness and selecting an appropriate location can take weeks or months, and the agency said it could not comment on where Girardi might end up.
A BOP forensic psychologist testified at a June hearing, during which a federal judge in Los Angeles heard evidence about whether Girardi should be sentenced to prison or a suitable medical facility and about how prisons can safely house people with dementia by, among other things, assigning them “inmate companions” to guide them through their days.
“The Bureau of Prisons does make accommodations for individuals who are aging and have significant medical issues,” said Brianna Grover, who works at a prison medical center in Butner, N.C.
Pressed on whether Girardi might end up living with violent, younger offenders or in “a concrete cell with a bunk bed,” Grover said it was possible — depending on what officials determined was the most appropriate facility for him.
Girardi exits federal court in August with Natalie Degrati, an investigator with the Federal Public Defender’s office.
(Brian van der Brug / Los Angeles Times)
Girardi’s lawyers have repeatedly predicted the worst.
“I have not seen an instance where I thought someone got good mental health care” in prison, J. Alejandro Barrientos, who was part of the team that represented Girardi during his trial, told The Times. He added: “If you’re elderly and serving a prison sentence, I think it’s kind of harsh in a way that it’s not harsh for someone who’s a lot younger.”
Until he was sentenced last month, Girardi’s defense team was imploring the trial judge to let him serve his prison term in the Orange County nursing home where he has spent the last four years. Incarceration, they contended, was a de facto death sentence given his age and ill health, and his lack of short-term memory meant he would have no understanding of why he was behind bars.
“For Tom Girardi, there can be no meaningful punishment,” Deputy Federal Public Defender Samuel Cross said at the sentencing hearing.
The judge rebuffed the argument after reviewing reports from Grover and a BOP neuropsychologist, both of whom examined Girardi earlier this year.
“They determined that he still possesses a baseline ability to function on a day-to-day basis, that he currently retains his independence as to his activities of daily living,” U.S. Dist. Judge Josephine L. Staton said from the bench in Los Angeles in June, ruling that prison was an appropriate punishment site.
State and federal prisons are increasingly confronting dementia among their inmates. Due to longer sentences from tough-on-crime initiatives of the past, the prison population is graying. More than 1 in 5 federal prisoners is older than 50, according to population data published by the Department of Justice. The number of prisoners suffering from dementia is difficult to determine, criminal justice experts say, as there are few research studies on inmates and little concrete data.
California has opened memory care operations in two correctional facilities, a 30-bed unit at the prison hospital in Stockton and a 35-bed unit in Vacaville. The federal BOP launched a 36-bed “memory disorder unit” in 2019 at the prison medical center in Devens, Mass.
Prior to Girardi, another disgraced figure in Southern California power circles, former L.A. County Sheriff Lee Baca, cited concerns about dementia care behind bars in trying to avoid prison. Baca was diagnosed with early stage Alzheimer’s in 2016 before he was sentenced to three years in prison for obstruction of justice and lying to FBI agents. Baca’s lawyers suggested his cognitive decline was a sentence of its own, but the judge presiding over his case rejected the argument.
“As awful as Alzheimer’s is, it is not a criminal penalty,” U.S. District Judge Percy Anderson told Baca at his sentencing, adding, “Alzheimer’s disease is not a get-out-of-jail card.”
Former Los Angeles County Sheriff Lee Baca, center, in 2017 stands with his wife and defense attorneys, including, right, current L.A. County Dist. Atty. Nathan Hochman.
(Damian Dovarganes / Associated Press)
The extent of Girardi’s cognitive decline has been the subject of dispute since 2020, when his firm imploded amid allegations of misappropriated funds. With clients demanding their money, Girardi’s brother had him placed in a conservatorship, citing as evidence a diagnosis of Alzheimer’s disease from a Long Beach psychiatrist.
The State Bar of California, which was going after Girardi’s law license, quickly cast doubt on the diagnosis, suggesting possible malingering, a refrain later picked up by federal prosecutors pursuing wire fraud charges. Experts in dementia retained by the government acknowledged that he had some cognitive decline, but found evidence he was exaggerating his symptoms.
Staton, who presided over his trial, embraced the view that Girardi was suffering from dementia but also malingering. She found him competent to stand trial.
After his August conviction, Girardi was sent to the Butner prison hospital for six weeks of observation. Tracy O’Connor Pennuto, a neuropsychologist for the federal prison system, determined he was not malingering and contributed to a report that concluded Girardi had “moderately advanced dementia” with “some features of Alzheimer’s.”
“His remote memory — or his long-term memory — was pretty well intact. It was more recent information that he had difficulty with,” Pennuto testified at the June hearing where evidence of his fitness for prison was presented to the judge.
That dynamic was on display when Girardi was called to the witness stand as part of the hearing last month. Though he had only left his nursing home to attend court, he maintained under oath that he had been crisscrossing the country.
“The International Academy had a meeting in New York. Then I had a case … in Oklahoma,” he testified, before mentioning stops in San Francisco, Las Vegas and Buffalo.
On the witness stand, Girardi claimed he lived in Pasadena, the location of his former mansion, which was sold in 2022 to pay creditors. As he walked back to his seat at the defense table, his pants began to fall down. When his lawyers tried to make an official record of the wardrobe malfunction, Staton, the judge, noted that Girardi “realized that that was happening, and reached down to pull them up and then maintained hold on them.”
In the Seal Beach dementia ward, Girardi has spent most days sitting alone at a table scribbling “hundreds of pages of unintelligible notes” on a pad, according to a letter his brother, Robert, wrote the judge. He added that Girardi believes he is still practicing as a lawyer.
Robert Girardi has covered the cost of his brother’s nursing home care, nearly $750,000 since 2021, according to his letter. If Girardi is sent to a prison hospital facility, the estimated cost to taxpayers will be at least $102,857 annually, according to government figures from 2022.
BOP officials have discussed sending Girardi to the agency’s Massachusetts dementia unit. It has aspects of a nursing home memory care ward with pink walls, festive decorations, music therapy, art classes and bocce ball, according to published reports. Other inmates act as caretakers for the unit’s residents.
The facility has come under criticism recently. A government audit found severe understaffing, which resulted in inadequate medical care. Only 16 of its 36 beds were filled at the time of the audit. Some violent inmates without dementia were housed in the dementia unit and posed “a safety risk” to other inmates and prison staff, the report found.
Girardi could also be sent to a regular prison, as Baca was. The former sheriff’s attorney, Benjamin Coleman, recalled that in the Texas prison, Baca had difficulty doing basic tasks, such as filling out the form for his wife and others to visit.
“He was fortunate that other inmates helped him with stuff,” Coleman said. “If it was up to him, he usually wouldn’t be able to do it.”
Another option for Girardi is a prison medical center in Texas, Kentucky, Minnesota, Massachusetts or North Carolina. During his month-and-a-half stay at the Butner medical center, Girardi had difficulty at times finding his way back to his bunk. All cells there have the inmate’s name and photo posted outside, but staffers had to take the additional step of enlarging Girardi’s photo.
While at the Butner facility, Girardi also refused to leave his cell for several hours at a time or stand for regular headcount, recalled Grover, the prison psychologist, who testified that he, on occasion, threatened staff with lawsuits.
Even with medical care, Girardi’s prognosis is poor, testified Pennuto, the neuropsychologist at Butner.
“He will not improve,” Pennuto said. “He will continue to decline over time.”