Title: McCauley v. Superintendent, Mass. Correctional Institution, Norfolk
Citation: N/A
Docket Number: SJC-13296
State: Massachusetts
Issuer: Massachusetts Supreme Court
Date: April 3, 2023

NOTICE:  All slip opinions and orders are subject to formal 
revision and are superseded by the advance sheets and bound 
volumes of the Official Reports.  If you find a typographical 
error or other formal error, please notify the Reporter of 
Decisions, Supreme Judicial Court, John Adams Courthouse, 1 
Pemberton Square, Suite 2500, Boston, MA, 02108-1750; (617) 557-
1030; SJCReporter@sjc.state.ma.us 
 
SJC-13296 
 
MARTIN McCAULEY  vs.  SUPERINTENDENT, MASSACHUSETTS CORRECTIONAL 
INSTITUTION, NORFOLK, & another.1 
 
 
 
Suffolk.     September 9, 2022. - April 3, 2023. 
 
Present:  Budd, C.J., Gaziano, Lowy, Cypher, Kafker, Wendlandt, 
& Georges, JJ. 
 
 
Parole.  Imprisonment, Parole.  Commissioner of Correction.  
Statute, Construction.  Regulation.  Administrative Law, 
Regulations.  Practice, Civil, Relief in the nature of 
certiorari.  Constitutional Law, Separation of powers.  
Words, "Debilitating." 
 
 
 
Civil action commenced in the Supreme Judicial Court for 
the county of Suffolk on March 1, 2021. 
 
Following transfer to the Superior Court Department, the 
case was heard by Maureen Mulligan, J., on motions for judgment 
on the pleadings. 
 
The Supreme Judicial Court on its own initiative 
transferred the case from the Appeals Court. 
 
 
Jeffrey G. Harris for the plaintiff. 
Stephanie M. Caffrey for the defendants. 
Mara Voukydis, Committee for Public Counsel Services, Tatum 
A. Pritchard, Jacob Addelson, David Milton, Lauren Petit, & Ada 
 
1 Commissioner of Correction. 
2 
 
Lin, for Prisoners' Legal Services of Massachusetts & others, 
amici curiae, submitted a brief. 
 
 
 
CYPHER, J.  Martin McCauley, the plaintiff, is a sixty-six 
year old man serving a life sentence without the possibility of 
parole for his conviction of murder in the first degree.  He 
petitioned for medical parole under G. L. c. 127, § 119A (§ 119A 
or statute), and the Commissioner of Correction (commissioner) 
denied his petition.  After two requests for reconsideration, 
which also were denied, he brought this action in the nature of 
certiorari in the Superior Court against the commissioner and 
the superintendent of the Massachusetts Correctional Institution 
at Norfolk (collectively, defendants).  In this opinion, we 
consider whether 501 Code Mass. Regs. § 17.02 (2019), which, in 
relevant part, defines "debilitating condition" for purposes of 
applying the statute, impermissibly narrows the group of 
prisoners who qualify for medical parole, and whether the 
commissioner abused her discretion in denying the plaintiff's 
request for medical parole.  We conclude that the regulation 
does not impermissibly narrow the scope of the statute, but that 
in spite of the commissioner's proper consideration of numerous 
relevant factors in making her decision, she abused her 
discretion in denying the plaintiff's petition where she did not 
3 
 
have the benefit of the standardized risk for violence 
assessment required by the regulations.2 
 
Background.  1.  Petition for medical parole and 
proceedings below.  On April 2, 2020, the plaintiff filed his 
initial pro se petition for medical parole pursuant to § 119A 
with the deputy superintendent of the Massachusetts Correctional 
Institution at Norfolk (MCI-Norfolk).  On April 17, 2020, his 
attorney filed a new petition on the plaintiff's behalf.  The 
plaintiff argued that he was permanently incapacitated, citing 
the opinions of Dr. Steven Descoteaux, the Wellpath3 medical 
director for the Department of Correction (department), and Dr. 
Michael Moore, medical director of MCI-Norfolk, and adding 
additional ailments from which the plaintiff reported he was 
suffering.  He urged that he is unlikely to return to violating 
the law if released because he is no longer "hooked on illegal 
drugs," he is older and wiser, and he has strong family support.4  
 
2 We acknowledge the amicus brief submitted by Prisoners' 
Legal Services of Massachusetts, the Disability Law Center, and 
the Committee for Public Counsel Services. 
 
3 The Department of Correction's (department's) medical 
provider. 
 
4 In the memorandum drafted in support of the plaintiff's 
petition, his attorney mentioned a 2015 disciplinary report 
related to the plaintiff's attempt to take pills from the hand 
of an officer, which resulted in his being "brought to the 
floor."  This report did not appear in the administrative 
record. 
4 
 
The plaintiff asserted that because of his "crippling 
challenges," his release was not incompatible with the welfare 
of society.  The plaintiff included a release plan recommending 
release to a family member. 
On April 28, 2020, the former superintendent of MCI-
Norfolk, Steven Silva, recommended against releasing the 
plaintiff on medical parole.5  In making his recommendation, 
Silva noted observations of a correction officer working on the 
unit where the plaintiff resides, who stated that the plaintiff 
does not need any assistance dressing, showering, or toileting, 
and that he walks outside frequently with his "rollator" walker, 
"at times quickly."  "Regarding the required assessment of the 
risk for violence that the inmate poses to society pursuant to 
G. L. c. 127, [§ 119A (c)]," Silva enclosed a copy of the 
plaintiff's most recent classification report and personalized 
program plan.  He noted that the plaintiff "does not receive a 
Risk or Needs Assessment" due to his sentence of life without 
parole.6  Because the plaintiff refused to participate in the 
 
5 Nelson Alves, the current superintendent of MCI-Norfolk, 
is the superintendent named in the commissioner's letters 
denying medical parole in August 2020 and February 2021. 
 
6 In the administrative record, there is a placeholder page 
that states, in large font, "Due to Inmate [McCauley] current 
sentence of First Degree Life A Risk Assessment was not 
completed." 
5 
 
Texas Christian University Drug Screen evaluation (TCUD),7 
recommended to address the plaintiff's substance use concerns, 
Silva could not provide information about the plaintiff's risk 
for improper substance use.  The plaintiff's 2020 classification 
report, discussed infra, indicated that the TCUD assessment 
would help to address concerns over his substance use, but that 
he declined to participate in 2017. 
The plaintiff's 2020 classification report resulted in a 
score of one, which suggested that he be placed in minimum 
custody.8  The classification report stated that he received a 
six for his current offense (murder in the first degree, armed 
robbery, and unlawfully carrying a firearm); a zero for severity 
of convictions within the last four years, history of escape 
attempts, history of prior institutional violence within the 
last three years, number of disciplinary reports within the last 
 
7 The evaluation consists of a form in which participants 
answer a series of substance use-related questions.  TCU 
Institute of Behavioral Research, TCU Drug Screen 5 (Sept. 
2020), https://ibr.tcu.edu/wp-content/uploads/2020/09/TCU-Drug-
Screen-5-Sept20.pdf [https://perma.cc/BC33-N8VL]. 
 
8 A prisoner can get a score of up to twenty-nine points on 
an initial classification and thirty-six points on 
reclassification.  A score of twelve or higher indicates that 
maximum custody is recommended; seven to eleven recommends 
medium custody; six or fewer recommends minimum custody.  
Department of Correction, Male Objective Point Base 
Classification Manual 8-17 (Nov. 18, 2019), https://www.mass 
.gov/doc/male-objective-point-base-classification-manual 
/download [https://perma.cc/DD5J-RQRM]. 
6 
 
twelve months, and most severe disciplinary report within the 
last twelve months; a minus three for his age; and a minus two 
for program participation and work assignment.  Because the 
plaintiff received a sentence of life without parole, a 
department restriction prevents him from being placed in minimum 
custody.  Therefore, it was recommended that he remain where he 
was and "[c]ontinue positive behavior and pursue the recommended 
programming."  The plaintiff's personalized program plan 
indicated that, among other things, anger and criminal thinking 
were not considered a "need area" for programming for the 
plaintiff. 
A department staff member spoke with the family member with 
whom the plaintiff planned to live, who stated that she lived on 
the second floor of a building with seventeen steps leading to 
the condominium.  The condominium itself easily is accessible 
with a rollator walker.  The plaintiff told his family member 
"that he has no issues using the stairs and that being on the 
second floor [would] not be a problem." 
Silva recommended that the plaintiff's petition for medical 
parole be denied, pointing to "his criminal history, the 
disturbing facts underlying [his] conviction, . . . 
institutional violence and extensive disciplinary issues, 
especially those involving drug transactions and the attempted 
introduction of heroin into the" facility.  Despite his medical 
7 
 
condition, the superintendent opined that the plaintiff 
presented a significant risk to public safety.9 
On June 5, 2020, the commissioner denied the petition.  She 
found that the plaintiff's medical conditions were not so 
debilitating that he did not pose a public safety risk.  As 
reasons therefore, she referenced the facts of the plaintiff's 
conviction, considering that he "has never agreed with the facts 
of his conviction"; his disciplinary history while incarcerated; 
the medical assessment conducted by Descoteaux and Moore; the 
accommodations that have been put in place to mitigate the 
effects of the plaintiff's medical condition; the plaintiff's 
various suggestions for home placement; Silva's submissions and 
recommendation; letters in support of the plaintiff's release; 
and the opinions of the district attorney's office as well as 
those of a relative of the victim.  Although the commissioner 
recognized both doctors' opinions that the plaintiff is 
permanently incapacitated, she stated that, given his 
accommodations including a leg brace, walker, and lower bunk 
assignment, "his permanent incapacitation is not so debilitating 
that he does not pose a public safety risk."  She also noted 
 
9 The office of the district attorney for the Suffolk 
district sent an e-mail message to the department regarding the 
plaintiff's application, stating that the office was unable to 
conclude, at that time, that the plaintiff satisfied the 
statutory criteria of § 119A. 
8 
 
that the plaintiff, allegedly, was suffering from his "left hand 
paralysis" when he killed the victim. 
On June 10, 2020, five days after the initial denial, the 
plaintiff requested reconsideration of the petition.  On 
August 17, 2020, the commissioner denied the petition again, 
considering additional medical records submitted by the 
plaintiff and the unchanged positions of the district attorney's 
office and the victim's wife.  The commissioner incorporated by 
reference all her reasons for denial in her June 2020 decision, 
and she noted that she did not find a material change in 
circumstances warranting reconsideration of her decision.10  On 
December 18, 2020, the plaintiff filed a second request for 
reconsideration of his petition, which the commissioner denied 
on February 2, 2021.  She considered the updated medical 
assessment conducted by Moore and Descoteaux.  She also 
considered the statement from the district attorney's office, 
which no longer opposed the plaintiff's request for medical 
parole, and which referenced the medical assessment indicating 
that he is permanently incapacitated and "the existence of a 
 
10 In Harmon v. Commissioner of Correction, 487 Mass. 470, 
477 (2021), we held that the mandatory language of G. L. c. 127, 
§ 119A (c) (1), does not permit the department to require "a 
significant and material decline in medical condition" to submit 
a new petition.  Consequently, we do not consider this reason in 
determining whether the commissioner's decision was an abuse of 
discretion. 
9 
 
sufficiently detailed release plan that provides for the 
reintegration of the defendant and, most importantly, the safety 
of the public."11  Despite these additional considerations, the 
commissioner determined that there was not "a significant and 
material" change in the plaintiff's circumstances, and denied 
the request for the reasons articulated in her previous 
decisions.  Because the plaintiff was able to care for himself 
with the accommodations provided to him, and referencing the 
reasons set forth in her prior decisions, she found that he 
would be unlikely to "live and remain at liberty without 
violating the law" and that his release would be "incompatible 
with the welfare of society." 
On March 1, 2021, the plaintiff commenced an action in the 
nature of certiorari in the county court pursuant to G. L. 
c. 249, § 4.  A single justice transferred the case to the 
Superior Court.  In May 2021, the plaintiff filed a motion for 
judgment on the pleadings; the defendants filed an opposition to 
the motion and a cross motion for judgment on the pleadings.  
After a hearing, a Superior Court judge denied the plaintiff's 
motion and granted the defendants' cross motion.  The judge 
found that the commissioner's decision was reasonable in the 
circumstances, in light of the plaintiff's prison disciplinary 
 
11 The commissioner again incorporated by reference her June 
and August 2020 decisions. 
10 
 
history, his ability to care for himself on a daily basis in the 
general prison population, and his ability to ambulate with the 
accommodation of a rollator walker.  The plaintiff appealed from 
the judge's decision to the Appeals Court, and we transferred 
the case to this court on our own motion. 
2.  Criminal case.  Following a jury trial, the plaintiff 
was convicted of murder in the first degree, two counts of armed 
robbery, and unlawfully carrying a firearm, and was sentenced to 
life in prison in March 1982.12  We affirmed his convictions.  
Commonwealth v. McCauley, 391 Mass. 697, 697-698 (1984), cert. 
denied, 534 U.S. 1132 (2002).  Those convictions stemmed from an 
incident in June 1981, in which two masked men entered a closed 
restaurant, brandished guns, and ordered employees to lie face 
down on the floor.  Id. at 698.  One of the gunmen encountered 
the victim, a comanager of the restaurant, who walked from the 
office to the dining room as his wife was hiding behind the 
office door.  Id.  The victim told the gunman, after being 
questioned, that the woman had left for the evening.  Id.  As 
the victim was directed to lie on the floor, he yelled for his 
wife to run.  Id. 
 
12 Including the murder charge, the plaintiff has had 
twenty-two adult arraignments and three juvenile arraignments.  
These resulted in six convictions, comprised of the following 
categories of crimes:  person, property, weapons, and drug 
offenses. 
11 
 
 
Subsequently, one gunman directed the employees, including 
the victim, out a side door into an alley after seizing their 
wallets and cash receipts.  McCauley, 391 Mass. at 698-699.  In 
the alley, the gunman, later identified as the plaintiff, said 
to the victim, "I like you.  You think you're smart."  The 
gunman then raised the revolver and shot the victim between the 
eyes from within six inches.13  Id. at 699.  The plaintiff was 
arrested three days later.  Id. at 700.  At a hearing on a 
pretrial motion to suppress the statements he had made to 
police, the plaintiff testified that, from the time of the crime 
until the time of his arrest, "he had not slept and had ingested 
at various times amounts of alcohol, heroin, Valium, cocaine, 
and methadone."  Id. at 701. 
 
3.  Plaintiff's medical condition.  According to the 
medical parole assessment conducted by Descoteaux and Moore, 
dated and updated January 4 and February 1, 2021, respectively, 
the plaintiff's medical conditions included chronic pain 
syndrome resulting from multiple failed back surgeries, spinal 
 
13 The employees testified that the shooter fired the gun 
with his right hand.  McCauley, 391 Mass. at 699.  The plaintiff 
told police that the shooting was an accident, and that he 
transferred the gun from his right to his left hand, causing the 
gun to fire accidentally because his hand was "paralyzed."  Id.  
A doctor testified that he had performed surgery on the 
plaintiff's left wrist five or six years earlier, which left the 
plaintiff with some numbness, but his hand was not "technically 
paralyzed."  Id. 
12 
 
stenosis,14 migraine15 headaches, benign prostatic hypertrophy 
(BPH),16 severe neuropathy17 confirmed by electromyography, 
abdominal wall incisional hernias,18 and peripheral leg swelling 
secondary to varicose veins.  Descoteaux reported that the 
plaintiff's migraine headaches and BPH are controlled with 
medication.  His hernias cause him discomfort.  He has foot 
drop,19 managed with a brace, related to permanent nerve damage.  
The swelling of his leg is treated with compression stockings. 
 
14 "Stenosis" is "[a] stricture of any canal or orifice," 
which, modified by "spinal," "[r]elating to any spine or spinous 
process" would mean a narrowing or restriction of the spine.  
Stedman's Medical Dictionary 1805, 1832 (28th ed. 2006). 
 
15 "Migraine" is defined as "[a] familial, recurrent 
syndrome characterized usually by unilateral head pain, 
accompanied by various focal disturbances of the nervous system, 
particularly in regard to visual phenomenon, such as 
scintillating scotomas."  Stedman's Medical Dictionary 1212. 
 
16 "Hypertrophy" is the "[g]eneral increase in bulk of a 
part or organ, not due to tumor formation."  Stedman's Medical 
Dictionary 929. 
 
17 "Neuropathy" is "a disease involving the cranial nerves 
or the peripheral or autonomic nervous system."  Stedman's 
Medical Dictionary 1313. 
 
18 A hernia is a "[p]rotrusion of a part or structure 
through the tissues normally containing it."  Stedman's Medical 
Dictionary 879. 
 
19 "Foot drop" is the "[p]artial or total inability to 
dorsiflex the foot."  Stedman's Medical Dictionary 756. 
13 
 
 
The plaintiff's ability to ambulate20 is compromised 
severely due to his condition, and he requires the use of a 
walker for his unsteady gait, caused by neuropathy resulting 
from spinal stenosis.  A walker was assigned to him in 2014, 
when the department classified him as "handicapped."  In January 
2020, the plaintiff reported that "[i]f it weren't for [his] 
walker, [he] would be falling a lot."  In February 2020, the 
plaintiff saw a neurosurgeon at Boston Medical Center.  The 
neurosurgeon recognized that "[h]is medical history is 
remarkable for [three] lumbar spine fusions," but determined 
that he was not a viable candidate for spinal cord stimulation 
due to the extent of his lumbar surgery.21  In October 2020, the 
plaintiff fell in his cell, injuring his shoulder, after his 
knee "gave out on him."  His unsteadiness is persistent, and he 
has fallen several times.  Despite his weakness, a Wellpath 
nursing progress note from July 2020 indicated that he was able 
to ambulate "with a steady gait with the assistance of a 
rollator walker without incident." 
 
20 Webster's Third New International Dictionary 67 (1993) 
defines "ambulate" as "to move from place to place." 
 
21 During a prior consultation with a doctor from Spaulding 
Rehabilitation Hospital, the doctor noted that the plaintiff was 
"able to walk without [an] assistive device," but expressed 
doubt that he would "have a good response to stimulation." 
14 
 
Given his limited mobility, several accommodations were 
made for the plaintiff at MCI-Norfolk.  In addition to his foot 
brace and his walker, he was given a knee sleeve (2004), first-
floor housing close to the health services unit (2005), a bottom 
bunk (2006), a hernia belt (2017), and an extra mattress and 
pillows (2018).  Since 2017, an order has been on file that 
ankle restraints are not to be used on him, and he requires 
transport by a State car. 
 
The plaintiff is prescribed "strong pain medication, which 
enables him to perform daily living activities."  The 
administrative record indicates that, at least as far back as 
May 2018, the plaintiff has been "maxed out in terms of his 
medications."  Among other things, he is prescribed oxycodone 
and morphine. 
 
The plaintiff completed a comprehensive mental health 
evaluation with Wellpath in March 2020, during which he 
presented "anxious and depressive symptomology."  In 2008, while 
incarcerated, the plaintiff was placed on mental health watch 
after he made a "suicidal gesture."  Later, he stated that he 
made this gesture "while drunk on straight vodka."  He also was 
placed on mental health watch on October 21, 2013, after 
suffering a drug overdose in prison.22 
 
22 The evaluation lists several positive factors that the 
plaintiff possessed, including, among others, family support, 
15 
 
 
Both Descoteaux and Moore found that the plaintiff is 
"significantly and permanently incapacitated" due to his lumbar 
spinal stenosis for which neurological consultation offered no 
significant improvement, particularly considering his four prior 
back surgeries.  This determination was characterized by his 
"permanent limitations and inability to walk unassisted" and 
indicated that he likely has been "incapacitated for months to 
years."  Despite his significant medical conditions, including 
his neuropathy, which is "expected to worsen with advancing 
age," he was not expected to die within the next eighteen months 
from his known diagnoses. 
 
4.  Plaintiff's disciplinary history.  The plaintiff's 
disciplinary history during his incarceration is extensive, but 
dated.  It consists of refusing to provide urine; possession of 
controlled substances; "insolence"; possession of contraband, 
such as weapons and a syringe; participating in a drug 
transaction; acting as a lookout while other inmates used 
controlled substances; "accumulating meds"; an assault on a 
correction officer with a food tray; and destruction of State 
property.  In September 1984, he was transferred after he was 
 
positive peer relationships, positive goal orientation, and 
treatment compliance.  It is worth noting, however, that the 
evaluation also indicates that the current charge or prior 
sentences did not relate to violent behavior, despite the 
plaintiff's conviction of murder in the first degree. 
16 
 
found to be in possession of valium.  In May 1986, he tested 
positive for methadone.  In December 1987, the plaintiff 
received a one and one-half year placement in the departmental 
segregation unit (DSU) for possessing six packets of marijuana 
and a syringe and being involved in a drug transaction with 
another inmate who possessed eighteen glassine packets of 
heroin.  In August 1990, he was placed in the DSU for another 
year after he was found in possession of "an eight and a half 
inch pick-type weapon" concealed in his mattress.  In July 1992, 
the plaintiff was transferred from MCI-Norfolk to Old Colony 
Correctional Center (Old Colony) because of his disruptive 
behavior.  In December of that same year, he was sent to the 
Massachusetts Correctional Institution at Cedar Junction after 
he was found to be involved in illicit drug activity in Old 
Colony, during which he orchestrated the transfer of $850 from 
his friend to a recreation officer for the introduction of 
heroin into the facility.  In June 1993, the plaintiff received 
a thirteen-month placement in the departmental disciplinary unit 
for this infraction. 
 
Once back at MCI-Norfolk, in January 2007, he was reported 
for being out of place in a vacant, dark, and empty floor of the 
facility with another inmate.  In September 2008, he cut a foam 
mattress and tested positive for alcohol on his arrival in the 
special management unit, and in October 2008, he was found in 
17 
 
possession of alcohol that he bought from another inmate.  After 
he was transferred to the Souza-Baranowski Correctional Center 
in March 2009, he received positive reviews, did not incur any 
disciplinary reports, and attended Alcoholics Anonymous meetings 
and church services.  In October 2013, after he had returned to 
MCI-Norfolk, he was taken to a local hospital for a medical 
emergency, and he admitted to consuming one-eighth of a piece of 
suboxone.  In October 2014, he admitted to having a large piece 
of rock on his walker. 
 
In February 2016, he admitted to damaging State property:  
another mattress.  That same year in September, he admitted to 
being in possession of another inmate's headphones, and in 
November, he admitted to showering during an unauthorized time 
period. 
 
Discussion.  1.  Legislative purpose and medical parole 
statute.  General Laws c. 127, § 119A, provides for a prisoner's 
ability to apply for, and be granted, medical parole where 
several requirements are met: 
"If the commissioner determines that a prisoner is 
terminally ill or permanently incapacitated such that if 
the prisoner is released the prisoner will live and remain 
at liberty without violating the law and that the release 
will not be incompatible with the welfare of society, the 
prisoner shall be released on medical parole." 
 
G. L. c. 127, § 119A (e).  "Permanent incapacitation" is defined 
by the statute as "a physical or cognitive incapacitation that 
18 
 
appears irreversible, as determined by a licensed physician, and 
that is so debilitating that the prisoner does not pose a public 
safety risk."  G. L. c. 127, § 119A (a). 
 
The statute commands that the superintendent of a 
correctional facility "shall" consider a written petition for 
medical parole.  G. L. c. 127, § 119A (c) (1).  The 
superintendent "shall" transmit to the commissioner, along with 
a recommendation, three different items:  a medical parole plan, 
a written diagnosis by a physician licensed to practice medicine 
under G. L. c. 112, § 2, and "an assessment of the risk for 
violence that the prisoner poses to society."23 
 
After receipt of a petition, the commissioner has forty-
five days in which to issue a written decision.  G. L. c. 127, 
§ 119A (e).  "If the commissioner determines that a prisoner is 
terminally ill or permanently incapacitated such that if the 
prisoner is released the prisoner will live and remain at 
liberty without violating the law and that the release will not 
be incompatible with the welfare of society, the prisoner shall 
be released on medical parole" (emphasis added).  Id. 
 
The statute gives the Secretary of the Executive Office of 
Public Safety and Security (Secretary) the authority to 
promulgate rules and regulations necessary for the statute's 
 
23 There are equivalent requirements for a sheriff.  G. L. 
c. 127, § 119A (d) (1). 
19 
 
enforcement.  G. L. c. 127, § 119A (h).  It also commands that 
the commissioner and Secretary file an annual report with the 
Legislature indicating information regarding those who applied 
for medical parole and those who were granted or denied medical 
parole, excluding any personally identifiable information.  
G. L. c. 127, § 119A (i).24  If a prisoner, sheriff, or 
superintendent is aggrieved by the decision of the commissioner, 
 
24 Pursuant to the reporting requirement of § 119A (i), five 
annual reports have been released by the department regarding 
medical parole:  for fiscal years 2018, 2019, 2020, 2021, and 
2022.  In 2018, five prisoners petitioned for medical parole, 
and none of them was released.  Report Regarding Medical Parole 
Required by MGL Chapter 127 § 119A to the Clerks of the House 
and Senate, the Senate and House Committees on Ways and Means, 
and the Joint Committee for the Judiciary (Mar. 1, 2019), 
https://www.mass.gov/doc/fy18-doc-medical-parole-report/download 
[https://perma.cc/ND8G-4JQE].  In 2019, twenty-four prisoners 
petitioned for medical parole, and four were granted release.  
Report Regarding Medical Parole (Mar. 10, 2020), https://www 
.mass.gov/doc/fy19-doc-medical-parole-report/download [https: 
//perma.cc/JLR9-2N68].  In 2020, 270 prisoners petitioned for 
medical parole, twenty-six were released, and as of the report's 
release date, a total of fifty-two prisoners had been granted 
medical parole.  Report Regarding Medical Parole (Dec. 1, 2021), 
https://www.mass.gov/doc/fy20-doc-medical-parole-report 
/download [https://perma.cc/9HN2-WL24].  In 2021, 211 prisoners 
petitioned for medical parole, seventeen were granted release, 
and a total of fifty-six inmates had been granted medical parole 
as of the date of the report.  Report Regarding Medical Parole 
(Feb. 8, 2022), https://www.mass.gov/doc/fy21-doc-medical-
parole-report/download [https://perma.cc/88DS-7GT5].  In 2022, 
sixty-seven prisoners petitioned for medical parole, seventeen 
were released, and as of the date of the report, sixty-nine 
total prisoners had been granted medical parole.  Report 
Regarding Medical Parole (Dec. 1, 2022), https://www.mass.gov 
/doc/fy22-doc-medical-parole-report/download [https://perma.cc 
/5CX2-5LYR]. 
20 
 
he or she may petition for relief in the nature of certiorari 
pursuant to G. L. c. 249, § 4 (§ 4).  G. L. c. 127, § 119A (g). 
 
2.  Regulations.  Since promulgation by the Secretary on 
July 26, 2019, the original regulations have undergone several 
changes, in large part due to decisions from this court 
declaring them partially or wholly invalid.  On April 15, 2022, 
an updated version of the regulations became effective.25 
 
At the time of the plaintiff's request for medical parole, 
the regulations provided that the superintendent's risk for 
violence assessment "shall" take several factors into 
consideration:  a prisoner's terminal illness or permanent 
incapacitation and prognosis; the prisoner's current housing 
situation; clinical management of the prisoner's medical 
condition; assessment for mobility, gait, and balance 
(considering the prisoner's confinement to bed or whether he or 
she is able to ambulate with the use of accommodations); any 
medically prescribed devices; the prisoner's ability to manage 
activities of daily living; a psychological assessment; advanced 
directives, such as a "do not resuscitate" order (DNR); and the 
prisoner's height, weight, and ability to eat on his or her own.  
501 Code Mass. Regs. § 17.05 (2019). 
 
25 The definition for "permanent incapacitation" in the 
regulation is identical to the definition in the statute, with 
the exception of "and" before "that is so debilitating."  501 
Code Mass. Regs. § 17.02 (2022). 
21 
 
The current version of the regulations indicates 
consideration of the same factors, minus the factor of advanced 
directives.  501 Code Mass. Regs. § 17.04(3) (2022).  The older 
version of the regulations, formerly at 501 Code Mass. Regs. 
§ 17.03(7)(d) (2019), required the superintendent to transmit to 
the commissioner the assessment for the risk of violence, "which 
shall utilize standardized assessment tools that measure 
clinical prognosis, such as the LS/CMI assessment tool and/or 
COMPAS, as well as risk level for classification evaluation 
purposes."  The current version, 501 Code Mass. Regs. 
§ 17.04(2)(d), (e) (2022), requires a multidisciplinary review 
team to provide information to the superintendent regarding the 
risk assessment, "which must be based upon the results of a 
standardized assessment tool that measures clinical prognosis, 
such as the LS/CMI assessment tool and/or COMPAS," in addition 
to a recent classification report.26 
 
3.  Validity of 501 Code Mass. Regs. § 17.02.  a.  Standard 
of review.  Where a statute authorizes the Secretary to 
promulgate rules and regulations to enforce and administer the 
statute, and where those regulations are duly promulgated, they 
"are presumptively valid."  Buckman v. Commissioner of 
Correction, 484 Mass. 14, 23 (2020), quoting Craft Beer Guild, 
 
26 There is no further description of these tools in the 
regulation or the record. 
22 
 
LLC v. Alcoholic Beverages Control Comm'n, 481 Mass. 506, 520 
(2019).  "Only an 'agency regulation that is contrary to the 
plain language of the statute and its underlying purpose may be 
rejected by the courts.'"  Massachusetts Teachers' Retirement 
Sys. v. Contributory Retirement Appeal Bd., 466 Mass. 292, 301 
(2013), quoting Duarte v. Commissioner of Revenue, 451 Mass. 
399, 408 (2008).  We apply a deferential review of the 
regulation, "and it is therefore 'unimportant whether we would 
have come to the same interpretation of the statute as the 
agency.'"  Massachusetts Teachers' Retirement Sys., supra, 
quoting Goldberg v. Board of Health of Granby, 444 Mass. 627, 
633 (2005). 
"[R]egulations are not to be declared void unless their 
provisions cannot by any reasonable construction be interpreted 
in harmony with the legislative mandate."  Harmon v. 
Commissioner of Correction, 487 Mass. 470, 476 (2021), quoting 
Dowell v. Commissioner of Transitional Assistance, 424 Mass. 
610, 613 (1997).  "Our deference is especially appropriate 
where, as here, the statute[] in question involve[s] an 
explicit, broad grant of rule-making authority."  Goldberg, 444 
Mass. at 634. 
 
We employ a two-step test to evaluate the legality of an 
agency's regulations.  Harmon, 487 Mass. at 476.  We first look 
to statutory language.  Id. at 476-477.  Where the statute 
23 
 
"speaks clearly on the topic in the regulation, we determine 
whether the regulation is consistent with or contrary to the 
statute's plain language."  Buckman, 484 Mass. at 24.  Where the 
relevant statute is ambiguous or leaves a gap in statutory 
guidance, we move to the second step, to "determine whether the 
regulation may 'be reconciled with the governing legislation.'"  
Id., quoting Craft Beer Guild, LLC, 481 Mass. at 520.  
"Statutory silence, like statutory ambiguity, often requires 
that an agency give clarity to an issue necessarily implicated 
by the statute but either not addressed by the Legislature or 
delegated to the superior expertise of agency administrators."  
Goldberg, 444 Mass. at 634. 
 
b.  Analysis.  Here, the plaintiff argues that 501 Code 
Mass. Regs. § 17.02 is invalid because its definition of 
"debilitating condition" impermissibly narrows the class of 
persons available for medical parole, by limiting availability 
to those who are unable to conduct basic activities of daily 
living.  He asserts that the statute's use of the term 
"debilitating" is "unambiguous," as it is modified by the phrase 
"that the prisoner does not pose a public safety risk."  The 
defendants argue that the regulation is valid because it 
reasonably fills a gap in the statute, which does not expressly 
define "debilitating" and includes a further description of the 
meaning of "debilitating."  We first examine whether the statute 
24 
 
is unambiguous with respect to its reference to "debilitating" 
conditions. 
 
The statute defines "permanent incapacitation" as "a 
physical or cognitive incapacitation that appears irreversible, 
as determined by a licensed physician, and that is so 
debilitating that the prisoner does not pose a public safety 
risk" (emphasis added).  G. L. c. 127, § 119A (a).  It further 
defines "terminal illness" as "a condition that appears 
incurable, as determined by a licensed physician, that will 
likely cause the death of the prisoner in not more than 
[eighteen] months and that is so debilitating that the prisoner 
does not pose a public safety risk" (emphasis added).  Id.  
Those are the only two occasions where the word "debilitating" 
appears in the statute. 
Typically, "[w]hen a statute does not define its words we 
give them their usual and accepted meanings, as long as these 
meanings are consistent with the statutory purpose. . . .  We 
derive the words' usual and accepted meanings from sources 
presumably known to the statute's enactors, such as their use in 
other legal contexts and dictionary definitions."  Williams v. 
Board of Appeals of Norwell, 490 Mass. 684, 693-694 (2022), 
quoting Commonwealth v. Morasse, 446 Mass. 113, 116 (2006). 
Where, however, as here, the statute expressly provides the 
power to the Secretary to "promulgate rules and regulations 
25 
 
necessary for the enforcement and administration" of the 
statute, the Secretary's interpretation of an important, 
undefined word, particularly where other important words and 
phrases are defined by the statute, warrants some deference.  
G. L. c. 127, § 119A (h).  "[I]f the Legislature has not 
addressed directly the pertinent issue [in the statute], we 
determine whether the agency's resolution of that issue may 'be 
reconciled with the governing legislation.'"  Zoning Bd. of 
Appeals of Amesbury v. Housing Appeals Comm., 457 Mass. 748, 
759-760 (2010), quoting Goldberg, 444 Mass. at 633.  At this 
stage in the analysis, we apply "'substantial deference' to the 
expertise and statutory 'interpretation of [the] agency charged 
with primary responsibility' for administering a statute. . . .  
[A] '[S]tate administrative agency in Massachusetts has 
considerable leeway in interpreting a statute it is charged with 
enforcing,' unless a statute unambiguously bars the agency's 
approach."  Zoning Bd. of Appeals of Amesbury, supra, quoting 
Goldberg, supra. 
The fact that the word "debilitating," in the statute, is 
modified by the phrase "that the prisoner does not pose a public 
safety risk" does not foreclose the Secretary, tasked with 
enforcement and administration of the statute, from further 
defining the term, and attempting to answer the unanswered 
question:  in what instance would someone be so debilitated that 
26 
 
he or she would not pose a public safety risk?  This is 
particularly true where the statute declines to define "public 
safety risk."  The importance of defining what "debilitates" 
someone to the point where he or she no longer poses a "public 
safety risk" is significant.  A more detailed definition of 
"debilitating" facilitates the administration of the statute by 
providing objective criteria that can be applied consistently 
from petition to petition in making a determination whether an 
individual poses a risk to public safety. 
Taking into consideration the statute's mandate that the 
Secretary promulgate regulations to enforce and administer the 
medical parole process, and given the fact that the statute 
defines "permanent incapacitation" and "terminal illness," the 
Legislature's silence on the definition of "debilitating" 
indicates that the Secretary had the discretion to identify 
factors that would assist the superintendent in determining 
whether a prisoner has a debilitating condition.  See, e.g., 
Massachusetts Teachers' Retirement Sys., 466 Mass. at 300.  We 
"view the Legislature's silence here as an invitation to [the 
Secretary] to fill the gap with appropriate regulation."  Id. at 
301. 
Next, where the statute leaves a gap for the Secretary to 
fill, we must "determine whether the regulation may 'be 
reconciled with the governing legislation.'"  Buckman, 484 Mass. 
27 
 
at 24, quoting Craft Beer Guild, LLC, 481 Mass. at 520 ("Where 
the statute relevant to the regulation is ambiguous or where 
there is a gap in the statutory guidance, we" move on to next 
step in our analysis of regulation).  The regulation defines 
"debilitating condition" as 
"[a] physical or cognitive condition that appears 
irreversible, resulting from illness, trauma, and/or age, 
which causes a prisoner significant and serious impairment 
of strength or ability to perform daily life functions such 
as eating, breathing, toileting, walking or bathing so as 
to minimize the prisoner's ability to commit a crime if 
released on medical parole, and requires the prisoner's 
placement in a facility or a home with access to 
specialized medical care" (emphasis added).27 
 
501 Code Mass. Regs. § 17.02.  The plain reading of the 
regulation is consistent with the legislative purpose of the 
statute to show compassion to those individuals who are least 
likely to offend, considering the poor health and age of the 
prisoner, while also considering savings in costs of health care 
for those who need serious care.  The plain language of the 
regulation does not require that a prisoner be incapable of 
performing all daily life functions, but some daily life 
functions. 
 
27 We discuss the regulation in effect at the time of the 
plaintiff's request for medical parole, with the understanding 
that the regulation has undergone minor changes.  The updated 
version, effective April 15, 2022, removed the language 
"resulting from illness, trauma, and/or age," and added 
"palliative or" before "medical care."  501 Code Mass. Regs. 
§ 17.02 (2022). 
28 
 
Contrary to the plaintiff's assertion that the regulation 
"redefined" the term "so debilitating" by limiting it to a 
question of ability to perform activities of daily living, the 
language used in the regulation indicates that the activities 
mentioned are examples for the commissioner to consider rather 
than an exclusive list.  Webster's Third New International 
Dictionary 2283 (2002) defines "such" as "someone or something 
that has been or is being stated, implied, or exemplified," and 
"such a one" as "one of a kind to be indicated or specified."  
Interpreting this phrase in the regulation according to its 
definition, the regulation does not limit daily life functions 
to those mentioned, but rather provides examples of what some 
daily life functions may be.  Accordingly, we remind the 
commissioner that a reasonable interpretation of the regulation 
would not require a prisoner to be unable to perform all 
activities of daily living, but only those that diminish the 
public safety risk a prisoner poses on release. 
We do not agree with the plaintiff that consideration of 
the ability to perform activities of daily living is not 
"logically related" to the determination whether a medical 
condition is "debilitating."  G. L. c. 127, § 119A (a).  
"Debilitate" is defined as "to weaken, . . . to impair the 
strength of."  Webster's Third New International Dictionary 582.  
As such, the regulation's discussion of ability to perform daily 
29 
 
life functions reasonably flows from the language used within 
the statute.  We can conclude that, by using the word 
"debilitating" in defining both "terminal illness" and 
"permanent incapacitation," the Legislature contemplated an 
individual's weakened ability to function. 
The plaintiff further argues that the regulation "serves to 
narrow the class of persons available for medical parole."  That 
the regulation provides examples of particular daily life 
functions does not reduce the number of persons who otherwise 
would qualify under the statute.  To the contrary, the 
regulation demonstrates the Secretary's appropriate use of 
expressly granted power to "promulgate rules and regulations 
necessary for the enforcement and administration of" the statute 
to provide guidelines to the commissioner in determining when 
individuals may suffer from a "debilitating" condition.  G. L. 
c. 127, § 119A (h).28 
 
28 Consideration of the ability to perform activities of 
daily living is contemplated in other statutes when defining 
similar terms.  General Laws c. 151B, § 1 (17), the unlawful 
discrimination code, defines "handicap" as "a physical or mental 
impairment which substantially limits one or more major life 
activities of a person," among other considerations (emphasis 
added).  In the same statute, "major life activities" are 
defined as "functions, including, but not limited to, caring for 
one's self, performing manual tasks, walking, seeing, hearing, 
speaking, breathing, learning and working."  G. L. c. 151B, § 1 
(20).  Similarly, 42 U.S.C. § 12102(1), the Federal equivalent, 
defines "disability" as, in part, "a physical or mental 
impairment that substantially limits one or more major life 
activities of such individual."  Title 42 U.S.C. § 12102(2) 
30 
 
Although statutes from other States allowing for some form 
of medical parole are written and implemented differently, 
several of those statutes and regulations use language 
discussing activities of daily living similar to our own.  
California's medical parole statute provides for release in 
certain circumstances for prisoners who are "permanently 
medically incapacitated with a medical condition that renders 
[them] permanently unable to perform activities of basic daily 
living."  Cal. Penal Code § 3550(a).  The regulation expands on 
this by identifying several activities of daily living:  
"breathing, eating, bathing, dressing, transferring, 
elimination, arm use, or physical ambulation."  15 Cal. Code 
Regs. § 3359.1(a)(1).  See In re Martinez, 210 Cal. App. 4th 
800, 817-818 (2012) (discussing considerations that are part of 
medical parole decision and stating that determination of 
whether inmate is "permanently medically incapacitated" as set 
forth in statute is "more explicitly defined" in regulations).  
The New Jersey medical parole statute defines "permanent 
physical incapacity" as a medical condition that renders one 
"permanently unable to perform activities of basic daily 
 
defines "major life activities" as including, but not limited 
to, "caring for oneself, performing manual tasks, seeing, 
hearing, eating, sleeping, walking, standing, lifting, bending, 
speaking, breathing, learning, reading, concentrating, thinking, 
communicating, and working." 
31 
 
living."  N.J. Stat. Ann. § 30:4-123.51e.  Neither the 
regulation nor the statute defines "activities of basic daily 
living."  N.J. Admin. Code § 10A:16-8.5.  See State v. F.E.D., 
251 N.J. 505, 511, 528 (2022) (construing statute "to require 
clear and convincing evidence that the inmate's condition 
renders him permanently unable to perform two or more activities 
of basic daily living, necessitating twenty-four-hour care" and 
looking to other laws in New Jersey that define "activities of 
basic daily living" to determine how to define it for medical 
parole purposes).  See also Ohio Rev. Code Ann. § 2967.05 & Ohio 
Admin. Code 5120:1-1-40 (statute states "medically 
incapacitated" includes consideration of disability that 
"prevents the inmate from completing activities of daily living 
without significant assistance," regulation sets out procedural 
process, and neither defines "activities of daily living").29 
Although Montana's medical parole statute does not use the 
language "activities of daily living," the administrative rules 
identify factors the decision-making body may consider.  See 
Mont. Code Ann. § 46-23-210; Mont. Admin. R. 20.25.307.  See 
 
29 Other jurisdictions whose medical parole statutes mention 
activities of daily living include Rhode Island (R.I. Gen. Laws 
§ 13-8.1-3), Colorado (Colo. Rev. Stat. § 17-1-102), Kentucky 
(Ky. Rev. Stat. Ann. § 439.3405), Louisiana (La. Rev. Stat. Ann. 
§ 15:574.20), Michigan (Mich. Comp. Laws § 791.235), Mississippi 
(Miss. Code Ann. § 47-7-4), and Oklahoma (Okla. Stat. tit. 57, 
§ 332.18). 
32 
 
also Madsen vs. Guyer, No. 18-0699 (Mont. Dec. 27, 2018) 
(medical parole "defined by statute"); Holm vs. Salmonsen, No. 
18-0557 (Mont. Oct. 16, 2018) (directing plaintiff to 
administrative rules concerning medical parole to provide 
guidance).  In Kansas, the medical parole statute lists factors 
to consider in determining whether a person is "functionally 
incapacitated."  Kan. Stat. Ann. § 22-3728(a)(8).  The 
regulations direct the decision-making party to consider the 
factors identified in the statute, "and the following additional 
factors[,]" naming the prisoner's age, medical condition, health 
care needs, custody classification, risk of violence, and 
effective capacity to cause physical harm as additional relevant 
factors.  Kan. Admin. Regs. § 45-700-2(b)(1)(C).  The statutes 
and regulations of these other States support our determination 
that consideration of ability to perform activities of daily 
living correlates with an individual's permanent incapacitation. 
 
Because § 119A contemplates cognitive incapacitation, we 
must address whether the regulation impermissibly excludes those 
who suffer from a qualifying cognitive condition in determining 
whether the regulation is valid.  G. L. c. 127, § 119A (a) 
(defining "permanent incapacitation").  The proper 
interpretation of this regulation, which contemplates a 
"cognitive condition," would not lead to the exclusion of those 
who are eligible for medical parole by reason of cognitive 
33 
 
incapacitation.  As discussed supra, the use of "such as" in the 
regulation indicates that the daily life functions mentioned in 
the statute are only examples of what may contribute to 
qualifying someone for medical parole. 
Consideration of other daily life functions, such as 
thinking, planning, concentrating, and working, may be more 
applicable when examining prisoners who are cognitively 
incapacitated, along with other daily life functions that are 
explicitly indicated in the regulations.  Indeed, functions such 
as thinking, planning, concentrating, or working may have an 
impact on the daily life functions that explicitly are indicated 
in the regulations, such as ability to breathe, eat, or walk on 
one's own.  We list other potential daily life functions solely 
to provide an illustration of those that may be connected to 
cognitive incapacitation. 
Notably, in response to questioning at oral argument, 
counsel for the defendants later submitted thirteen medical 
parole decisions in which the commissioner released petitioners 
on medical parole who suffered from various forms of cognitive 
incapacitation, such as dementia and Alzheimer's disease.30  In 
four of those decisions, the commissioner released petitioners 
primarily suffering from dementia, recognizing that it had an 
 
30 Only one of those decisions was a result of a remand 
following judicial review. 
34 
 
impact on those petitioners' comprehension, reasoning, judgment, 
memory, and insight.  In two petitions, the commissioner 
specifically noted that despite needing prompting, the 
petitioners still were able to perform all or most physical 
activities of daily living independently, but released them 
nonetheless due to their cognitive incapacities. 
We advise the commissioner to continue to analyze each 
petition individually, and to consider all activities of daily 
living, including those that could be implicated by cognitive 
incapacitation, not just those enumerated in the regulation as 
examples, as she appeared to do properly in the petitions 
discussed in the preceding paragraph.  Giving substantial 
deference, as we must, to the Secretary, the statute "may 'be 
reconciled with the governing legislation.'"  Buckman, 484 Mass. 
at 24, quoting Craft Beer Guild, LLC, 481 Mass. at 520. 
After considering whether a prisoner petitioning for 
medical parole has an irreversible physical or cognitive 
condition, as set out by 501 Code Mass. Regs. § 17.02 and the 
statute, the commissioner then must consider whether this 
condition is so debilitating that the prisoner "does not pose a 
public safety risk," § 119A, and "minimize[s] the prisoner's 
ability to commit a crime if released," 501 Code Mass. Regs. 
§ 17.02. 
35 
 
Contrary to the plaintiff's assertion that the ability to 
perform activities of daily living is disconnected from an 
individual's risk to public safety, those who suffer from 
conditions that prevent or hinder their performance of certain 
activities of daily living are objectively less likely to pose a 
public safety risk, making it an appropriate consideration in 
determining whether to release a prisoner on medical parole.  It 
is difficult to neatly describe the nexus between physical 
incapacitation and the inability to commit a crime.  Different 
debilitating conditions likely would incapacitate an individual 
in different ways.  For example, a petitioner who is 
quadriplegic likely would not be able to shoot a gun, and a 
petitioner who cannot walk may not be able to rob a bank.  
Activities of daily living that may be hindered in those cases 
may include, among others, bathing and walking, which are listed 
explicitly in 501 Code Mass. Regs. § 17.02. 
A petitioner who suffers from severe dementia may have 
difficulty writing a "bad" check or robbing a bank.  For that 
individual, the activities of daily living he or she may have 
difficulty performing may include speaking, thinking, reading, 
writing, or expressing thoughts that, in turn, may implicate the 
functions mentioned in 501 Code Mass. Regs. § 17.02, such as 
eating, breathing, or toileting.  The regulation's discussion of 
activities of daily living does not narrow impermissibly the 
36 
 
scope of the statute; rather, it facilitates the statute's 
administration in a consistent manner by aiding in the 
determination of when a prisoner's condition may implicate the 
risk posed to public safety on his or her release. 
The Supreme Court of New Jersey recently endeavored to 
construe two requirements of its medical parole statute:  that a 
prisoner be "permanently physically incapable of committing a 
crime if released" and "would not pose a threat to public 
safety."31  F.E.D., 251 N.J. at 531, quoting N.J. Stat. Ann. 
§ 30:4-123.51e(f)(1).  The court reasoned that the "physically 
incapable" language could not require that a prisoner be 
incapable of committing any criminal offense, because, in that 
case, "only an inmate who is so debilitated or incapacitated 
that he cannot speak with a co-conspirator to plan a crime or 
type on a computer to commit an offense could be eligible for 
compassionate release," which would contravene the intent of the 
Legislature and render superfluous the language regarding a 
threat to public safety.  F.E.D., supra at 531-532.  For a 
prisoner asserting a "permanent physical incapacity," in order 
for the "public safety" requirement to have meaning, the court 
interpreted the "physically incapable" language to mean whether 
 
31 New Jersey's medical parole statute is unique in that it 
allows a court to determine whether a prisoner qualifies for 
compassionate release.  N.J. Stat. Ann. § 30:4-123.51e. 
37 
 
the prisoner is physically incapable, either alone or with 
assistance, of committing the same crime or similar crimes to 
those of which he or she was convicted.  Id. at 532-533.  Then, 
in analyzing the public safety risk the prisoner presents, the 
"inquiry is not limited to the threat that the inmate may commit 
any specific crime or category of crimes," but instead involves 
a "comprehensive assessment" of all the relevant factors.  Id. 
at 533. 
Our statute is not so limiting; it requires a determination 
not that the prisoner is "physically incapable" of violating the 
law, but that he or she "will live and remain at liberty without 
violating the law" and that the prisoner's release is not 
"incompatible with the welfare of society."  G. L. c. 127, 
§ 119A (e).  Both prongs require a more comprehensive look, on a 
case-by-case basis, at various considerations.  The regulations 
and the statute do not explicitly list the factors that the 
commissioner should consider in making this determination, 
unlike the medical parole statutes and regulations of some other 
States.32 
 
32 For example, Montana's administrative rules provide 
factors to consider in the public safety analysis, such as 
whether a prisoner's physical condition renders him or her 
unable to engage in criminal activity, any statement from the 
victim, the progression of his or her medical condition 
documented by a licensed physician, a prisoner's "conduct, 
employment, and attitude" in prison, any physical or mental 
evaluations that have been completed, a prisoner's social and 
38 
 
Nonetheless, in addition to the ability to perform 
activities of daily living, the commissioner's decision should 
include discussion of the following factors:  a written 
diagnosis from a licensed physician (501 Code Mass. Regs. 
§ 17.04); any proposed medical parole plan (same); a risk for 
violence assessment, which should consider all the circumstances 
mentioned supra (same); a classification report (same); the 
superintendent's recommendation (same); and written statements 
and opinions submitted by a district attorney, victim, or family 
member of a victim (501 Code Mass. Regs. § 17.06).33  The 
superintendent's recommendation, risk for violence assessment, 
or classification report, as in this case and in Carver v. 
Commissioner of Correction, 491 Mass.     (2023), may 
incorporate the prisoner's disciplinary record and the severity 
of his or her crime, which may in turn be considered by the 
commissioner in making a decision.34  The commissioner's 
 
criminal record, and the circumstances of the offense for which 
a prisoner is incarcerated.  Mont. Admin. R. 20.25.307. 
 
33 We cite the factors where they appear in the current 
version of the regulations. 
 
34 Title 103 Code Mass. Regs. § 420.08 (2017) discusses 
factors to consider in the reclassification of prisoners, 
including, but not limited to, the prisoner's criminal history, 
the personalized program plan, work and housing evaluations, 
disciplinary history, and segregation placements.  Thus, where 
501 Code Mass. Regs. § 17.04 specifically mentions the provision 
of a classification report to the commissioner, she may consider 
the information contained within that report. 
39 
 
determination as to whether a prisoner is so debilitated that he 
or she does not pose a public safety risk should result from a 
comprehensive approach, considering all the factors implicated 
by the particular case. 
 
4.  Denial of plaintiff's petition.  a.  Standard of 
review.  "The standard of review for a certiorari action depends 
on the nature of the action for which review is sought."  
Mederi, Inc. v. Salem, 488 Mass. 60, 67 (2021).  "[W]here, as 
here, the decision being reviewed implicates the exercise of 
administrative discretion, the court applies the 'arbitrary or 
capricious' standard, which is more deferential to the party 
defending the administrative action it took."  Id., quoting 
Revere v. Massachusetts Gaming Comm'n, 476 Mass. 591, 605 
(2017).35  This standard is generous to the decision-making 
 
35 The medical parole process is not "adjudicatory."  For 
example, the Administrative Procedure Act "defines 
'[a]djudicatory proceeding' as 'a proceeding before an agency in 
which the legal rights, duties or privileges of specifically 
named persons are required by constitutional right or by any 
provision of the General Laws to be determined after opportunity 
for an agency hearing'" (emphasis added).  Milligan v. Board of 
Registration in Pharmacy, 348 Mass. 491, 494 (1965), quoting 
G. L. c. 30A, § 1 (1).  Section 119A permits a hearing where the 
prisoner was charged with a particular crime and the district 
attorney or victim's family requests it.  G. L. c. 127, 
§ 119A (c) (2).  Title 501 Code Mass. Regs. § 17.07 (2022) 
allows the commissioner to hold a hearing, but does not require 
her to, and largely leaves the procedure and permissible 
attendees of the hearing to the discretion of the commissioner; 
she "shall not be bound by the laws of evidence observed by the 
courts of the Commonwealth."  "Unless an adjudicatory hearing is 
required by constitutional right or statute, the fact that some 
40 
 
party, and only requires "that there be a rational basis for the 
decision."  Mederi, supra. 
The commissioner does not have unbridled discretion.  The 
statute demands: 
"The commissioner shall issue a written decision . . . .  
If the commissioner determines that a prisoner is 
terminally ill or permanently incapacitated such that if 
the prisoner is released the prisoner will live and remain 
at liberty without violating the law and that the release 
will not be incompatible with the welfare of society, the 
prisoner shall be released on medical parole" (emphasis 
added). 
 
G. L. c. 127, § 119A (e).  Nonetheless, the commissioner has 
discretion, as set out by statute, to determine whether the 
prisoner meets the three criteria set out by statute, namely, 
(1) whether the prisoner is terminally ill or permanently 
incapacitated such that (2) he or she will live and remain at 
liberty without violating the law, and (3) that release will not 
be incompatible with the welfare of society.  Id.  "The medical 
parole statute vests the commissioner with the authority to 
grant medical parole and requires the commissioner to do so 
where the commissioner finds that certain conditions have been 
met."  Emma v. Massachusetts Parole Bd., 488 Mass. 449, 455 
(2021). 
 
type of hearing is permitted or required does not imply that it 
is adjudicatory.  We must look to the nature of the proceeding 
below."  Sierra Club v. Commissioner of the Dep't of Envtl. 
Mgt., 439 Mass. 738, 746 (2003). 
41 
 
Although the commissioner "shall" release the prisoner when 
she finds that the three criteria are satisfied, the discretion 
that she retains in determining whether the prisoner meets those 
criteria should not be disregarded.  Particularly, the second 
two prongs -- whether the prisoner will live and remain at 
liberty without violating the law, and whether the prisoner's 
release will be incompatible with the welfare of society -- are, 
as discussed supra, comprehensive fact-intensive questions that 
leave room for differences in opinion among those analyzing the 
same record.  The commissioner's discretion is not a small 
component of the criteria to be applied; to the contrary, 
prisoners are released under the statute in her discretion 
alone, on her consideration of the factors mentioned by the 
statute or the regulations.  G. L. c. 127, § 119A (e) ("If the 
commissioner determines . . ." [emphasis added]).  In light of 
the discretionary nature of these determinations, an "arbitrary 
or capricious" standard is appropriate.  Compare Diatchenko v. 
District Attorney for the Suffolk Dist., 471 Mass. 12, 31 (2015) 
(Diatchenko II) ("Because the decision whether to grant parole 
to a particular juvenile homicide offender is a discretionary 
determination by the board, . . . an abuse of discretion 
standard is appropriate"), Sierra Club v. Commissioner of the 
Dep't of Envtl. Mgt, 439 Mass. 738, 745-748 (2003) (applying 
arbitrary or capricious standard to commissioner's findings 
42 
 
where nonadjudicatory process and exercise of powers and duties 
delegated to him for purpose of implementing legislative 
policy), and Forsyth Sch. for Dental Hygienists v. Board of 
Registration in Dentistry, 404 Mass. 211, 217 (1989) (applying 
arbitrary and capricious standard of review because "board is 
free to use its judgment in determining when and to whom to 
grant exemptions from its regulations" in exercise of its 
administrative discretion), with Black Rose, Inc. v. Boston, 433 
Mass. 501, 503-505 (2001) (reviewing decision suspending 
entertainment license under substantial evidence test, relying 
on cases applying that standard to license revocation 
proceedings under same statute), Saxon Coffee Shop v. Boston 
Licensing Bd., 380 Mass. 919, 924-925 (1980) (applying 
substantial evidence test to revocation of common victualler's 
license as revocation proceedings are required by statute and 
adjudicatory in nature), Lovequist v. Conservation Comm'n of 
Dennis, 379 Mass. 7, 8, 17-18 (1979) (reviewing decision of town 
conservation commission denying application to construct access 
road over old cranberry bog under substantial evidence 
standard), and Boston Edison Co. v. Boston Redev. Auth., 374 
Mass. 37, 50-54 (1977) (substantial evidence test appropriate 
where projects approved under G. L. c. 121A primarily are 
"conceived of and implemented by" private corporations who 
receive large public benefits and where tendency exists to 
43 
 
review "in more depth the decisions of urban renewal agencies").  
Where this discretion explicitly is conferred on the 
commissioner by the Legislature, we must give the commissioner's 
decision regarding the release of a prisoner under the statute 
deference.36  See, e.g., Ciampi v. Commissioner of Correction, 
452 Mass. 162, 168 (2008) ("Each of the challenged regulations 
and policy is entirely within the commissioner's broad grant of 
authority . . . to maintain prison discipline and is consistent 
with the Legislature's intent"); G. L. c. 27, § 5 (granting 
parole board power to determine who shall be released on 
parole). 
 
b.  Analysis.  The plaintiff argues that the commissioner's 
decision to deny him medical parole was erroneous because the 
department did not conduct a risk assessment on him; he does not 
have a history of institutional violence; his disciplinary 
history is not extensive, and was heavily drug-related, which 
ceased when he was prescribed pain medication; his ability to 
move around with a walker does not make him a threat to the 
 
36 The defendants argue that the plaintiff's assertion that 
the commissioner's decision is due no deference was raised for 
the first time on appeal.  Arguably, the plaintiff raised this 
in his motion for judgment on the pleadings where he stated:  
"The [c]ommissioner's expertise is limited to institutional 
order alone, and the deference required to be given to the 
[c]ommissioner's judgment on issues of public safety . . . is 
minimal."  Nonetheless, we conclude that this argument has no 
merit. 
44 
 
public; and the accommodations he has been given in prison 
should not have been considered.  The defendants counter that 
the commissioner's decision was not arbitrary or capricious, 
because her determination that the plaintiff is not so 
"permanently incapacitated" within the meaning of the medical 
parole statute that he "does not pose a public safety risk" was 
reasonable in light of the record.  The defendants point to the 
plaintiff's physical ability to conduct daily living activities, 
with the assistance of the restrictions put in place by the 
prison, and argue that a risk assessment that satisfies the 
statute was conducted by the superintendent in his 
recommendation letter. 
 
At the outset, and as discussed supra, § 119A requires the 
commissioner to determine three things:  whether the prisoner is 
(1) "terminally ill or permanently incapacitated such that" 
(2) "if the prisoner is released the prisoner will live and 
remain at liberty without violating the law" and (3) "that the 
release will not be incompatible with the welfare of society."  
G. L. c. 127, § 119A (e).  The definition of permanent 
incapacitation in the statute refers to "a physical or cognitive 
incapacitation that appears irreversible" and "that is so 
debilitating that the prisoner does not pose a public safety 
risk."  G. L. c. 127, § 119A (a).  Given this language, it 
appears that the commissioner must consider, generally, whether 
45 
 
a prisoner is likely to abide by the law.  Additionally, the 
commissioner must consider the public safety risk imposed by the 
prisoner's release.  The third prong of subsection (e) appears 
to subsume the "public safety risk" concern; if an individual's 
release poses a public safety risk, then naturally his or her 
release is incompatible with the welfare of society.  It is with 
this standard in mind that we consider whether the 
commissioner's decision in the plaintiff's case was arbitrary or 
capricious. 
 
An "assessment of the risk for violence that the prisoner 
poses to society" is required by § 119A.  G. L. c. 127, 
§ 119A (c) (1), (d) (1).  Despite its mention in the statute, 
only the regulations specify what that assessment should entail.  
As discussed supra, at the time of the plaintiff's request for 
medical parole, 501 Code Mass. Regs. § 17.05 indicated that the 
risk for violence assessment conducted by the supervisor must 
take several factors into consideration, including the 
prisoner's medical condition, management of that medical 
condition, the prisoner's housing situation, assessment of the 
prisoner's ability to ambulate with or without accommodation, 
medical devices prescribed for the prisoner, the prisoner's 
ability to manage daily living activities, a psychological 
assessment, advanced directives or DNR, and the prisoner's 
physical characteristics and his or her ability to eat 
46 
 
independently.  Additionally, 501 Code Mass. Regs. § 17.03(7)(d) 
required the superintendent to transmit a risk for violence 
assessment utilizing "standardized assessment tools . . . , such 
as the LS/CMI assessment tool and/or COMPAS, as well as risk 
level for classification evaluation purposes." 
 
Although the classification report was provided, there is 
nothing in the record to indicate that the superintendent used 
"standardized assessment tools . . . , such as the LS/CMI 
assessment tool and/or COMPAS."  In fact, the superintendent 
stated in his recommendation: 
"Regarding the required assessment of the risk for violence 
that the inmate poses to society . . . , I have enclosed 
for your review a copy of [the plaintiff's] most recent 
Classification Board and Personalized Program Plan.  Due to 
his sentence of life without parole, he does not receive a 
Risk or Needs Assessment, therefore, one could not be 
provided" (emphasis added). 
 
A risk for violence assessment is required by the regulation, as 
evidenced by the word "shall."37  The superintendent must follow 
the specific requirements as promulgated by the Secretary.  In 
this case, Silva (or the multidisciplinary review team, as 
 
37 In the current version, 501 Code Mass. Regs. 
§ 17.04(2)(d) uses the phrase "must be based upon" when 
referring to a standardized assessment tool.  See 501 Code Mass. 
Regs. § 17.04(2)(d) ("a risk for violence assessment, which must 
be based upon the results of a standardized assessment tool that 
measures clinical prognosis, such as the LS/CMI assessment tool 
and/or COMPAS").  As the parties did not raise the issue of the 
validity of this regulation, we assume without deciding that it 
is valid for the purposes of our analysis. 
47 
 
mentioned in the current regulation) should have ensured that a 
risk assessment, based on a standardized assessment tool, was 
conducted in order to comply with the regulations.  If the 
plaintiff had not received a risk for violence assessment based 
on a standardized assessment tool as specified in the 
regulation, the superintendent needed to facilitate such an 
assessment before he sent his recommendation to the 
commissioner.  When the commissioner reviewed the record and saw 
that it had not been completed, she should have inquired further 
about obtaining such an assessment.38 
 
Silva did address many of the factors set out by the 
regulation in his recommendation.  He discussed the plaintiff's 
medical condition, the medical assessments performed by 
department physicians, the accommodations put in place to assist 
the plaintiff in conducting daily living activities -- including 
his housing placement -- and the plaintiff's ability to 
ambulate, as viewed by prison staff.  He also discussed the 
medical parole plan developed by the plaintiff, and provided the 
classification report to the commissioner.  A number of these 
 
38 We recognize that the strict timeline set out by the 
statute in processing petitions for medical parole may make it 
difficult to conduct assessments that have not yet been 
administered.  See G. L. c. 127, § 119A (c) (1) (superintendent 
shall send recommendation not more than twenty-one days after 
receipt of petition).  Even so, the regulation, drafted by the 
Secretary, requires such an assessment. 
48 
 
factors specifically were mentioned in 501 Code Mass. Regs. 
§ 17.05 at the time of the plaintiff's petition, and therefore 
are proper to consider in determining whether the absence of the 
standardized assessment invalidated the commissioner's decision.  
Nonetheless, the statute requires an assessment for the risk of 
violence that the prisoner poses to society, and the regulations 
specify that this must be based on a standardized assessment 
tool.  See G. L. c. 127, § 119A (h) (Secretary to promulgate 
regulations "necessary for the enforcement and administration of 
this section").  Although the commissioner had a classification 
report, a recommendation from the superintendent, and other 
documentation that comprehensively catalogued the plaintiff's 
medical condition, his substance use concerns, his convictions, 
and his disciplinary history, the absence of the standardized 
risk assessment required by the regulation compels us to remand 
the petition for reconsideration after such an assessment is 
conducted.39  Despite the fact that a standardized risk 
 
39 We may not presume that the "[r]isk [a]ssessment" defined 
in the regulations pertaining to classification of prisoners is 
the equivalent of the "risk for violence" assessment required by 
the medical parole statute in the absence of any language in the 
medical parole regulations referencing this definition, despite 
the superintendent's mention of a "Risk or Needs Assessment."  
See 103 Code Mass. Regs. § 420.05 (defining risk assessment as 
"[t]he identification, evaluation, and estimation of the levels 
of criminogenic risk factors which are characteristic of an 
inmate or his or her situation which then assist in predicting 
future criminal behavior").  Contrast 501 Code Mass. Regs. 
§ 17.04(2)(d) (2022) ("a risk for violence assessment, which 
49 
 
assessment is but one relevant factor that the commissioner 
could have considered in making her decision, it is a 
consideration required by the regulation, and we cannot 
acquiesce to its absence. 
Notwithstanding our conclusion that the petition must be 
remanded for the administration and consideration of a risk for 
violence assessment based on a standardized assessment tool, we 
analyze the commissioner's consideration of the other factors 
that are disputed by the parties.  "A decision is not arbitrary 
and capricious unless there is no ground which 'reasonable 
[persons] might deem proper' to support it."  Garrity v. 
Conservation Comm'n of Hingham, 462 Mass. 779, 792 (2012), 
quoting T.D.J. Dev. Corp. v. Conservation Comm'n of N. Andover, 
36 Mass. App. Ct. 124, 128 (1994).  The commissioner's 
consideration of other factors discussed infra was reasonable 
given the entire administrative record.40 
 
must be based upon the results of a standardized assessment tool 
that measures clinical prognosis, such as the LS/CMI assessment 
tool and/or COMPAS"). 
 
40 That the district attorney's office opined that the 
plaintiff should be released does not render the commissioner's 
decision an abuse of discretion.  Although the opinion of the 
relevant district attorney is a factor provided for in the 
regulations, the commissioner alone has the discretion to decide 
whether a prisoner qualifies for medical parole.  See G. L. 
c. 127, § 119A (e); 501 Code Mass. Regs. § 17.06(2) (2022). 
50 
 
One of the factors that the commissioner properly 
considered was the plaintiff's disciplinary history, as 
indicated in his classification report and described in the 
superintendent's recommendation.  The plaintiff's early years of 
incarceration were marked with extensive disciplinary 
violations, resulting in numerous transfers of correctional 
facilities due to his behavior.  Although many of those 
violations were drug and alcohol related, some of them could be 
characterized as "violent," namely, the report of his assault on 
a correction officer, his possession of "an eight and a half 
inch pick-type weapon," and his having a large piece of rock on 
his walker in 2014.  Although these infractions are not recent, 
it was not unreasonable to consider them.  We may not substitute 
our judgment as to the weight or value of the infractions for 
that of the commissioner.  Cf. Diatchenko II, 471 Mass. at 30 
("The purpose of judicial review here is not to substitute a 
judge's or an appellate court's opinion for the board's judgment 
on whether a particular juvenile homicide offender merits 
parole, because this would usurp impermissibly the role of the 
board"). 
Similarly, it was not unreasonable to consider the 
plaintiff's ability to perform seemingly all his daily life 
functions using the accommodations provided to him, another 
factor mentioned by the regulations.  This indicates that he is 
51 
 
not bedridden and that he is able to perform tasks on his own, 
which is relevant to his ability to "violat[e] the law" on his 
release.  G. L. c. 127, § 119A (e).  As discussed supra, a 
person who is confined to bed and unable to perform any tasks on 
his or her own would be less able to violate the law than one 
able to move around with a walker.  This is not to say that 
those who can perform some activities of daily living on their 
own may not be released on medical parole.  Nonetheless, the 
consideration of this ability is a factor pertinent to the 
commissioner's decision.  The record indicated that a correction 
officer observed the plaintiff walking "outside a lot with a 
rollator [walker], at times quickly."  It is not the fact that 
accommodations were provided to the plaintiff that is relevant, 
but his ability to function independently in society with proper 
accommodations. 
Further, it was not an abuse of discretion to consider the 
severity and the facts of the plaintiff's crime for which he is 
incarcerated as a factor in determining whether he would be a 
risk to the safety of the public, which was included in both his 
classification report and the superintendent's recommendation.  
The statute does not exclude those who have been convicted of 
murder in the first degree from receiving medical parole.  G. L. 
c. 127, § 119A.  Nonetheless, where someone has been convicted 
of the most serious crime, punished by a mandatory sentence of 
52 
 
life without the possibility of parole, the facts of that crime 
are relevant to the determination whether the person will be a 
risk to the safety of the public on release.  G. L. c. 265, 
§ 2 (a) (if convicted of murder in first degree, person "shall 
be punished by imprisonment in the [S]tate prison for life and 
shall not be eligible for parole"). 
Given the purpose of medical parole, a petitioner's refusal 
to admit guilt should not be counted against him in the medical 
parole context.41  See, e.g., Deal v. Massachusetts Parole Bd., 
484 Mass. 457, 469-470 (2020) (Gants, C.J., concurring), quoting 
Quegan v. Massachusetts Parole Bd., 423 Mass. 834, 837 (1996) 
("although we did not reach the question, we recognized that due 
process might forbid 'denial of parole solely because a 
prisoner, who was otherwise fully qualified for release on 
parole, did not acknowledge his guilt'"); Commonwealth v. Mills, 
436 Mass. 387, 400 & n.9 (2002) ("a judge may not punish a 
defendant for refusing to confess before sentencing" as it is 
"impermissible [to] enhance[] a defendant's punishment for his 
exercise of a constitutional right").  "Indeed, if a prisoner's 
failure to acknowledge guilt alone were to suffice to support a 
denial of parole, a prisoner wrongfully convicted of murder 
 
41 The commissioner's passing reference to the plaintiff 
"never agree[ing] with the facts of his conviction" does not 
invalidate the other, more prevalent factors discussed 
throughout the decisions. 
53 
 
. . . might never be paroled unless he or she falsely accepted 
responsibility for a crime he or she never committed."  Deal, 
supra at 470.  Nonetheless, the commissioner may consider a 
petitioner's acceptance and acknowledgement of the facts of his 
or her conviction in determining whether he or she will pose a 
public safety risk on release, as suggesting some level of 
reform or personal growth.  See Mills, supra at 400 n.9 ("a 
defendant's willingness to admit guilt is a proper factor for 
consideration in more lenient sentencing"). 
The facts of the plaintiff's conviction in the present 
case, notwithstanding its age, are a particularly important 
factor to consider where he shot a stranger in the head with a 
firearm from less than six inches away in the course of an armed 
robbery.  McCauley, 391 Mass. at 699.  Even though his medical 
condition likely would make it much more difficult to commit a 
crime of this nature, it is not such that it would render him 
incapable of using a firearm to kill another, or incapable of 
committing various other crimes. 
The plaintiff also points to the fact that, since he has 
been prescribed oxycodone and morphine, he has not had any 
disciplinary reports for illicit drug use.  That the plaintiff 
no longer is consuming unprescribed medication does not 
alleviate completely the danger of his drug dependence.  It is 
fair to assume that if he is granted medical parole, his 
54 
 
consumption of pain medication will not be as restricted as in a 
prison setting.42  This is particularly of concern where the 
record indicates discipline for "accumulating meds."43 
This is not to say that drug dependence alone, or concerns 
surrounding illegal drug use, would suffice to suggest a public 
safety risk or imply that a prisoner would not be able to live 
and remain at liberty with the law if released.  Nonetheless, in 
this case, where the plaintiff himself stated at a hearing on a 
motion to suppress that during the crime he was under the 
influence of numerous substances, the plaintiff's drug 
dependence closely relates to the risk that he poses to the 
public on release, and his extensive disciplinary history 
surrounding drug activity was an appropriate factor for the 
commissioner to consider. 
Putting that aside, the statute demands release where the 
prisoner is "permanently incapacitated such that if the prisoner 
 
42 It also bears notice that the plaintiff, in the past 
(2008), was placed on mental health watch after making a 
"suicidal gesture" when he, in his own words, was "drunk on 
straight vodka" while being monitored in prison. 
 
43 We do not presume that any drug testing that could be 
ordered by the parole board on release could prevent a public 
safety risk posed by the plaintiff's substance use concerns.  Of 
course, drug testing does not prevent an individual from 
consuming drugs; it merely enables the court or the parole board 
to remedy a violation after it already has occurred.  It is for 
the parole board to revise, alter, or amend conditions of 
release if a prisoner is granted release pursuant to the 
statute.  G. L. c. 127, § 119A (f). 
55 
 
is released the prisoner will live and remain at liberty without 
violating the law and that the release will not be incompatible 
with the welfare of society" (emphasis added).  G. L. c. 127, 
§ 119A (e).  The statute does not require contemplation whether 
the prisoner will commit the same crime, but, in a more general 
sense, as discussed supra, requires the commissioner to consider 
whether the prisoner's condition renders him or her unlikely to 
violate the law, and whether release would be compatible with 
the welfare of society. 
The plaintiff shot and killed a stranger from within six 
inches while under the influence of numerous substances.  
McCauley, 391 Mass. at 699, 701.  He committed this crime while 
suffering from numbness in his hand.  Id. at 699.  In prison, he 
has garnered extensive disciplinary reports, including refusing 
to provide urine, possession of controlled substances and 
contraband, participating in a drug transaction, accumulating 
medication, assaulting a correction officer with a food tray, 
and possession of a weapon.  He suffered from a drug overdose 
and made a "suicidal gesture" when impaired by alcohol.  Despite 
his admitted history with substance use concerns, in 2017, he 
refused to participate in a drug screen recommended to address 
those concerns.  Although he is permanently incapacitated from a 
medical perspective, he is able to perform nearly all daily 
living activities with accommodations.  The above factors 
56 
 
support the commissioner's decision that he would be unable to 
remain at liberty without violating the law and that his release 
would be incompatible with the welfare of society, and are 
proper to be considered on remand along with the risk for 
violence assessment. 
Even so, we think it would be beneficial for the 
commissioner to be more explicit about the factors considered 
and her reasoning when making a determination whether to release 
a prisoner on medical parole.  Here, it appears that the 
commissioner considered the above-mentioned factors, in addition 
to the plaintiff's medical condition at the time of his 
conviction, the medical assessment conducted by licensed 
physicians, the plaintiff's medical parole plan, letters in 
support of the plaintiff's release, and the opinions of the 
victim's family and the district attorney's office.  The 
commissioner noted that she was "in receipt" of all the above 
information, but failed to explain why she concluded that the 
plaintiff did not meet the requirements of the statute and did 
not mention the absence of a risk assessment as it relates to 
meeting the requirements of the regulation.  Such an explanation 
is imperative not only so the prisoner may prepare a relevant 
response, but also so the court may properly analyze whether the 
determination is arbitrary or capricious.  We urge the 
57 
 
commissioner to prepare a more detailed explanation of her 
decision going forward. 
 
5.  Certiorari review under G. L. c. 249, § 4.  Finally, 
the defendants argue that the court lacks the authority to grant 
medical parole on certiorari review or to order the commissioner 
to grant a prisoner medical parole.  The plaintiff argues that 
the court does have this authority, pointing to a handful of 
Superior Court judges who already have done so and comparing the 
grant of parole, a discretionary act, to the grant of medical 
parole, which the plaintiff characterizes as a nondiscretionary 
act.  Although we are remanding the petition for the 
commissioner to consider a risk for violence assessment to be 
conducted in accordance with the regulations, we address this 
issue to provide clarification going forward.  Lynn v. Murrell, 
489 Mass. 579, 583 (2022). 
 
As is a decision by the parole board to grant parole, 
"[t]he decision [to grant medical parole] is a discretionary one 
for the [commissioner] 'with which, if otherwise 
constitutionally exercised, the judiciary may not interfere.'"  
Diatchenko II, 471 Mass. at 21, quoting Commonwealth v. Cole, 
468 Mass. 294, 302 (2014).  Again, the commissioner has the 
discretion to determine whether the petitioner poses a public 
safety risk on release:  a multifaceted decision considering a 
wide array of relevant factors.  On review pursuant to § 4 of a 
58 
 
decision regarding medical parole, an appellate court or a judge 
of the Superior Court does not have the power to substitute its 
judgment for that of the commissioner regarding whether a 
prisoner merits release on medical parole.  To do so would 
"usurp impermissibly the role of the" commissioner and would 
violate art. 30 of the Massachusetts Declaration of rights 
requiring strict separation of judicial and executive powers.  
See Diatchenko II, supra at 28, 30.44 
We recognize the plaintiff's assertions that several 
Superior Court judges already have taken this action.  This 
decision is to be applied to actions in certiorari decided after 
the issuance of this decision.  Going forward, judges who review 
the commissioner's decision to grant or deny medical parole may 
not independently grant or deny medical parole, nor may they 
 
44 In Diatchenko II, the court held in the parole context 
that a reviewing court may not reverse a decision by the parole 
board even where it finds an abuse of discretion; rather, it 
must remand the case to the board for rehearing.  Id. at 31.  In 
making this determination, the court addressed the dissent's 
concern that "without the affirmative power to grant parole 
after a denial by the board, this limited form of judicial 
review has the potential to result in an endless cycle of board 
hearings and actions for certiorari, until the board ultimately 
grants parole."  Id. at 31 n.33.  The court expressed that it 
was unlikely this would happen, as such decisions would be rare, 
given the deference that is afforded to the board and the 
limited scope of judicial review.  Id.  If that were to occur, 
the court "assume[d] that at a new hearing, the board [would] 
remedy the error or errors that caused the matter to be 
remanded."  Id.  We think that a remand to the commissioner in a 
medical parole case would follow the same pattern, for the 
reasons set forth in Diatchenko II.  Id. 
59 
 
command the commissioner to grant or deny medical parole.  Where 
a judge finds that the commissioner's decision is arbitrary or 
capricious, such that there is no reasonable ground to support 
it or because it is not in compliance with the regulations, the 
judge must remand the petition to the commissioner for 
reconsideration of the prisoner's petition.  A remanding judge 
should plainly indicate what, within the commissioner's original 
decision, is arbitrary or capricious or violative of the medical 
parole regulations, so that the commissioner may squarely 
address the problem identified by the judge. 
 
Conclusion.  Title 501 Code Mass. Regs. § 17.02 does not 
impermissibly narrow the scope of G. L. c. 127, § 119A, when 
applied properly by the commissioner.  In addition, a judge 
reviewing a decision granting or denying medical parole may not 
substitute his or her judgment for the commissioner and order 
that medical parole be granted.  Instead, the proper procedure 
is to remand to the commissioner for reconsideration consistent 
with the opinion of the reviewing court.  Determining that the 
commissioner's decision to deny the plaintiff medical parole was 
arbitrary and capricious because it was made without the benefit 
of a standardized risk assessment required by the regulation, we 
remand the matter to the commissioner for reconsideration of the 
petition and require that a standardized assessment be 
conducted. 
60 
 
 
 
 
 
 
 
 
So ordered. 
BUDD, C.J. (concurring).  I agree that the regulations 
concerning the definition of "debilitating condition" as found 
in 501 Code Mass. Regs. § 17.02 (2019) are valid under the 
medical parole statute.  I further agree that the matter must be 
remanded so that the statutorily mandated risk for violence 
assessment may be completed and taken into consideration.  
However, in light of the ordered remand, it is my view that the 
court should refrain from analyzing the decision of the 
Commissioner of Correction (commissioner) at this juncture. 
As the court acknowledges, at the time of the plaintiff's 
request for medical parole, 501 Code Mass. Regs. § 17.03(7)(d) 
(2019), required that an assessment of a petitioner's risk for 
violence "utilize standardized assessment tools that measure 
clinical prognosis, such as the LS/CMI [(Level of Service/Case 
Management Inventory)] assessment tool and/or COMPAS 
[(Correctional Offender Management Profiling for Alternative 
Sanctions)], as well as risk level for classification evaluation 
purposes."  The plaintiff's potential risk for violence is the 
crux of his appeal; thus, such an assessment would have been 
particularly relevant to the commissioner's evaluation of the 
petition.  Nevertheless, the court goes on to analyze in 
piecemeal fashion the commissioner's evaluation of the 
information she had at her disposal without regard for the fact 
that a risk for violence assessment was not a factor in her 
2 
 
decision.  Prematurely providing an analysis of the 
commissioner's decision risks depriving the defendant of an 
opportunity to have all of the statutorily required factors 
evaluated in a comprehensive manner because it sends a message 
that the factors need not be considered in their totality. 
Having said that, and keeping in mind that the arbitrary 
and capricious standard of review requires a rational basis for 
the commissioner's decision, I note a few areas where the 
commissioner's decision appears to lack support.  First, to the 
extent that the commissioner relies on the plaintiff's 
disciplinary history as an indicator of future risk to public 
safety, I do not see a rational basis to conclude that the 
plaintiff is unlikely to live without violating the law based on 
the vague and dated incidents contained in the plaintiff's 
disciplinary record.1  The only reported incidents in the record 
 
1 Although it is unclear whether the commissioner gave any 
weight to the sporadic instances of institutional rule 
violations (e.g., being out of place in 2007 and showering 
during an unauthorized time and damaging a mattress in 2016), to 
the extent she did base her decision on these technical rule 
violations as indicators of an inability to live within the law, 
such a conclusion is without rational support.  Not only are 
these instances too old in time to be useful, but even if they 
were recent, at most they suggest the potential for technical 
violations of any conditions of release that may be set by the 
parole board, a process governed separately from the 
commissioner's responsibility and authority under G. L. c. 127, 
§ 119A (e).  See Emma v. Massachusetts Parole Bd., 488 Mass. 
449, 458-459 (2021) (parole board has "same authority over 
medical parolees as it does over standard parolees" and retains 
3 
 
suggesting the potential for violence is an infraction from 
August 1990, where the plaintiff was found in possession of "an 
eight and a half inch pick-type weapon" concealed in his 
mattress.  As this infraction was over twenty years ago, it is 
too stale to be relevant to a decision on the plaintiff's 
petition.2  Absent any recent infractions that suggest a current 
risk for violent or unlawful behavior, the plaintiff's 
disciplinary report did not contain information to rationally 
support the commissioner's conclusion that, if released, the 
plaintiff likely would not live in the community without 
violating the law.  Similarly, the commissioner's reference to 
the fact that the plaintiff "never agreed with the facts of his 
conviction," without more, is not specific evidence of likely 
recidivism. 
Requiring the commissioner to base her decision on recent 
information to assess risk is rational.  For example, in the 
context of the Sex Offender Registry Board (SORB), tasked with 
"determining the level of risk of reoffense and the degree of 
 
discretion "not to initiate revocation proceedings for a 
'technical violation'"). 
 
2 The certified record indicates that the plaintiff had a 
rock on his walker in 2014 and also includes a reference to 
"assaulting a [correction officer] with a food tray."  No 
further details were provided regarding the latter incident, 
including the date that it occurred.  However, the location of 
the referenced incident within the record suggests it dates back 
to the 1980s. 
4 
 
dangerousness posed to the public" for individuals who come 
before SORB for classification review, G. L. c. 6, § 178K (1), 
we have stated that "[e]nsuring that a sex offender's final 
classification reflects a level of risk and dangerousness that 
is current at a time when the offender's release is imminent 
furthers both SORB's interest, and that of the public," Doe, Sex 
Offender Registry Bd. No. 7083 v. Sex Offender Registry Bd., 472 
Mass. 475, 488 (2015).  To that end, we have held that 
information predating SORB's classification consideration by 
three years is too stale to be reasonably relied on for a 
determination of risk to public safety.  Doe, Sex Offender 
Registry Bd. No. 3839 v. Sex Offender Registry Bd., 472 Mass. 
492, 501 (2015).  Accord Doe, Sex Offender Registry Bd. No. 6904 
v. Sex Offender Registry Bd., 82 Mass. App. Ct. 67, 78 (2012) 
(risk and recidivism information four years prior to release was 
stale).  Although the SORB classification process differs in 
many ways from the medical parole process, the same sound logic 
as to how to assess rationally present and future risk to public 
safety applies to both.  This is true especially where the 
concept of medical parole is premised on "the fact that elderly 
and infirm prisoners are 'considered among the least likely to 
re-offend when released.'"  Buckman v. Commissioner of 
Correction, 484 Mass. 14, 21 (2020), quoting Brownsberger, 
Extraordinary Medical Release in the Criminal Justice Package 
5 
 
(June 30, 2018), https://willbrownsberger.com 
/extraordinary-medical-release [https://perma.cc/K9SJ-MLPW]. 
Similarly, the plaintiff's disciplinary record indicates 
that his substance use disorder has been under control for 
almost a decade.  Thus, to the extent the commissioner relies on 
this history to conclude that the plaintiff poses a public 
safety risk, the record offers no rational support for a present 
or future risk of substance use disorder.  Moreover, reliance on 
this historical evidence of substance use disorder also ignores 
the statutory provisions authorizing and directing both the 
commissioner and the parole board to implement and maintain 
appropriate supervision conditions, including drug testing.3  See 
G. L. c. 127, § 119A (e), (f).  See also Malloy v. Department of 
Correction, 487 Mass. 482, 486 & n.9 (2021) (noting that "the 
parole board must take steps to prepare for adequate supervision 
of the prisoner," including, but not limited to, "supervision 
for drugs and alcohol").  Failing to consider an applicable 
 
3 Where the purported concern for this plaintiff is to 
prevent overuse of medications properly prescribed by a 
physician, consideration of drug testing as a condition of 
release may even fall within the Department of Correction's 
burden to produce a "proposed course of treatment" within the 
medical parole plan.  G. L. c. 127, § 119A (a).  See Buckman, 
484 Mass. at 29. 
6 
 
statutory provision that would ameliorate any potential relapse 
concerns is arbitrary and capricious.4 
Finally, because in the medical parole context even a 
single instance of remand and reconsideration may consume time a 
petitioner does not have, I urge both the commissioner and any 
reviewing Superior Court judge to move expeditiously in this 
process, lest the right to judicial review, and the statute's 
purpose itself, be rendered illusory by unnecessary delays.  Cf. 
Malloy, 487 Mass. at 492 ("For terminally ill prisoners entitled 
to spend their final days in freedom, each day is critical"); 
Harmon v. Commissioner of Correction, 487 Mass. 470, 478 (2021) 
(commissioner's "inexplicable delay" in acting on petition for 
reconsideration "effectively eliminated [petitioner]'s 
opportunity to seek judicial review before his death"). 
 
4 We need not speculate whether the commissioner is aware of 
the role and purpose of § 119A (e) and (f), as the examples 
provided postargument show that she has utilized these 
provisions to condition release in other cases.  Thus, any 
attenuated concern over the plaintiff's potential for relapse 
seems patently arbitrary where the commissioner did not avail 
herself of § 119A (e) or (f) in this case, but did so in others.  
Cf. Fafard v. Conversation Comm'n of Reading, 41 Mass. App. Ct. 
565, 568 (1996) ("agency has acted arbitrarily because the basis 
for action is not uniform, and, it follows, is not 
predictable").