The fate of 40,000 prison inmates in California now rests in the hands of the United States Supreme Court.

Criticizing California’s 20-year failure to provide inmates with adequate health care, the Justices weighed whether the release of these inmates would compromise public safety.

Without the ability to provide adequate medical care to its overpopulated prisons, critics have accused the State of violating the Eighth Amendment’s prohibition of “cruel and unusual punishments.”

“When are you going to avoid the needless deaths that were reported in this record?” Justice Sonia Sotomayor said during oral arguments. “When are you going to get around people sitting in their feces for days in a dazed state? When are you going to get to a point where you are going to deliver care that is going to be adequate?”

California prisons hold 164,000 inmates, double the intended capacity. Last year a three-judge panel gave California two years to reduce the number of inmates to 137.5% of capacity (about 110,000 prisoners).

Justice Stephen Breyer was shocked by photographs of prison conditions in the court record: “The pictures are pretty horrendous to me. It’s obvious. Just look at it. You cannot have mental health facilities that will stop people from killing themselves and you cannot have medical facilities that will stop staph and tubercular infection in conditions like this.”

Justice Samuel Alito, however, disagreed with the three-judge panel, and he questioned the nexus between overcrowding and inadequate health care. “Why order the release of all those people, rather than ordering the provision of the construction of facilities for medical care, facilities to treat mental illness, hiring of staff to treat mental illness? Why not go directly to the problem rather than address what seems to be a different issue altogether?”

A decision is expected by July.