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Humane Treatment for Terminally Ill Prisoners

by Kevin W. Bliss

“No prisoner dies alone.” That’s the motto of a group of prisoners, pastoral care workers and other volunteers at the California Medical Facility’s (CMF) hospice program, one of only two licensed prison hospices in the state. Begun in the early 1990s during the height of the AIDS crisis, it has since started housing more elderly prisoners dying from other causes. 

To get into one of the 17 hospice beds at CMF, a prisoner must receive a diagnosis of no more than six months to live. He must also sign a do-not-resuscitate order. The hospice’s goal is to help prisoners find peace while dying.

CMF houses 2,400 prisoners, primarily in drab concrete cells. But the hospice area has colorful quilts, pictures on the walls, curtains on the windows, jigsaw puzzles and a tropical fish tank. The outdoor area behind the unit, referred to as the “dog-run,” has been turned into a garden. It provides a “healing space” for families.

“Very commonly family, and friends, and sometimes family who are victims, will come here,” said Chief Medical Executive Dr. Joseph Blick. “There’s a lot of restorative justice that happens in this kind of setting.”

Prisoners who volunteer to work in the hospice program must first pass a series of interviews, submit to random drug tests and have their disciplinary history reviewed before being assigned to one of the lowest-paying jobs in California’s prison system. 

According to the New York Times, Fernando Murillo, Kao Saephanh, Kevion Lyman, Michael Watkins and Daren Hatfield are just a few of the prisoners who volunteer to help the dying brush their teeth, get dressed, take showers and eat their meals. Most importantly, they are there to hold a terminally ill prisoner’s hand in the last hours of their life. 

Directed by prison chaplain Keith Knauf, the volunteers receive 70 hours of training which includes videos on hospice care and comfort, psychological and physical end-of-life dynamics, bedside etiquette and the stages of grief, as well as informational programs from outside speakers on such topics as compassion fatigue. When a patient is put on death vigil, it is the pastoral care workers who maintain a 24-hour bedside watch. 

“I befriend somebody when they’re perfectly healthy, walking around, I’ll take care of them when they’re unable to talk and eventually hold their hands when they are taking their last breaths,” said Murillo. “I’ll listen to people’s regrets, their stories, their happiness, their joy. I’ll listen to their confessions.”

The program in California is one of about 80 nationwide, many of which are modeled after one begun in 1988 at the Louisiana State Penitentiary in Angola. Over 80 percent of the 6,500 prisoners at Angola are serving life sentences, so many expect to die behind bars. 

Jamey Boudreaux, a social worker for the Louisiana-Mississippi Hospice and Palliative Care Organization, said that when Angola prisoners became terminally ill before the program began, “they simply put them on a stretcher in a room so that they wouldn’t disturb anybody else. When they stopped moaning, they literally tied up the sheet [the prisoner] was laying on, dug a hole, dumped their bodies [into it] and then covered them up.”

Boudreaux and his organization started the prison hospice program at Angola. In cells once used for solitary confinement they created rooms like studio apartments, with air conditioning and TVs.

“It gives the families and the inmate some privacy,” Boudreaux stated.

What makes the program special is the involvement of other prisoners as volunteers, each of whom receives 40 hours of training to join a dying prisoner’s four-person rotation team that performs hospice duties. As a result, Boudreaux said, there is more compassion and less violence at the prison.

“I remember going into [the warden’s] office and him throwing a piece of paper, saying: ‘Look at this – I haven’t had a fist fight in 90 days,’” he recalled. “That’s all because of what’s going on at that hospice.’”

A similar program that began in 2004 in Pennsylvania transformed a group of prisoner volunteers at SCI Graterford’s hospice – who were once known as “the death squad” or “executioners” – into a source of comfort for people like Miriam Rodriguez and her brother Frank, who spent 10 weeks in the hospice program before he died in August 2017.

Family members who visit the program are limited to one hour a day, but for prisoners who are dying, their fellow prisoner volunteers man four-hour shifts, assisting with grooming tasks, offering massages and reading from the Bible. Miriam Rodriguez said they even cooked her brother his favorite foods – fish soup and sausage with rice.

Barb March, the hospice program’s coordinator and sole nurse, said most of the volunteer prisoner workers she supervises are serving life sentences, so they are well aware they may eventually die in the program’s narrow cinderblock room. 

A hospice designed for Minnesota prisoners in 2006 does not use other offenders as caregivers. Instead, a social worker from an outside group – HealthEast Hospice – counsels dying prisoners about end-of-life issues. Joan Wolff, health services administrator at the Oak Park Heights correctional facility, said the important thing is “allowing the patient to die with dignity.”

Though aware of the success of hospice programs that use prisoner volunteers, Minnesota officials haven’t been able to overcome their fears of the risk that involves in a maximum-security setting. But Nanette Larson, director of health services for the state’s Department of Corrections, remarked, “Hopefully that’s our next step.”

In 2016, all Pennsylvania prisons were ordered to set up hospice programs, but not all have opted for a prisoner-led model like the one that began at SCI Graterford, which was moved to SCI Phoenix after Graterford closed in 2018. [See related article on p.24]. At SCI Laurel Highlands, the hospice is in a skilled nursing unit staffed solely by medical professionals, according to program director Annette Kowalewski.

“Hospices in the correctional setting are a critically needed response to the extraordinarily long sentences and minimum mandatory sentences that were handed down over the past decades,” noted Brie Williams, a University of California-San Francisco professor who studies geriatric care for prisoners.

Though constitutionally mandated to provide appropriate treatment, Williams said there are many interpretations of what’s appropriate and no standardized protocol for assessing prison hospices, which face challenges due to shortages of trained staff and pain medications, along with problems creating advance healthcare directives for terminally ill prisoners.

The number of prisoners age 55 and older in the U.S. grew 280 percent between 1999 and 2016 even as conviction rates fell for younger offenders, and it is anticipated that by 2030, one of every three prisoners will be geriatric. Cancer, HIV and liver disease eventually leave elderly prisoners dependent on caregivers to dress them and push their wheelchairs, while dementia leaves others unable to remember where they are or what crimes they committed. 

Fueled largely by increased costs for medical care associated with the aging prison population, expenditures on corrections at the state level reached $57 billion in 2016, according to The Sentencing Project.

In addition to hospice programs for dying prisoners there are also efforts to help them obtain “compassionate release.” However, “very few people are getting out,” admitted Mary Price, general counsel for Families Against Mandatory Minimums. Except for Iowa, every state and the District of Columbia offers some form of compassionate release or conditional medical parole for terminally ill prisoners, but “nobody uses it to the extent that it ought to be used,” Price added.

“While I like the idea of compassionate release, you have to make sure that it’s compassionate,” said Boudreaux, who argued that care from people you trust can feel much more compassionate than being released to die at a nursing home where a former prisoner doesn’t know anyone and is surrounded by strangers.

“The guys [at the Angola hospice program] – they know each other,” he explained. “They’ve been locked up together for 35 years together. That is their family.” 



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