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Dying with Dignity

By D.S. Tyson

Prison is a tough place. Yet Enoch’s plight is not as grim as it might have been. McCain Correctional Hospital, where Enoch is serving six years for assault with a deadly weapon, provides health care for ailing patients.The prison is about two hours due south of Alamance County along N.C. 211, just east of Southern Pines. It is the only prison facility in the state that offers the level of care prisoners like Enoch need.

Enoch sleeps in a real hospital bed — a big step up from the steel cot with a blue woolen blanket that other inmates sleep on. The infirmary at McCain has an open-door policy, which means the guards allow him to meander outside, into a fenced-in yard, if he has the strength. One day not too long ago, Enoch wished for a grilled cheese sandwich, and the next day he got it. Enoch paused briefly to catch his breath and for nurse Steve Donohoe to administer medication.

“I believe you should go naturally,” he said in a voice made gravelly by years of hard living. “B ut it sure is nice knowing that somebody cares for you when you die. It takes a lot of pressure off .” And unlike prisoners in the past, Enoch, a Burlington native, will not receive treatment alone. His fellow inmates will watch over him.

Although Enoch is not sick enough for hospice care, McCain is in the forefront of the answer to a pressing question: What can be done with aging and dying prisoners?

Longer mandatory sentences, tougher policies that keep criminals behind bars when they are no longer a physical threat to others, and the quadrupling of the nation’s prison population during the past 20 years have led to more dying prisoners. At the same time, the prison population is growing older, forcing state prison officials to find a new way of caring for the infirm. Nationwide, inmate deaths rose to 3,029 in1999 from 727 in 1980, according to U.S. Justice Department figures.

One positive development is that AIDS deaths have declined significantly in recent years because of new drugs. The prison death rate from that disease has held relatively steady over the last few years. “We have more prisoners than ever,” said Herbert Rosefield, former director of McCain Correctional Hospital. “They have longer sentences and their average age is increasing. All you have to do is look at the math and you know what is going to happen.”

Some prison officials, including Susan Eason, McCain’s health treatment administrator, advocate compassion release, or medical parole. But victims’ rights advocates counter that violent criminals, even feeble ones, should remain behind bars. “We don’t want to hear all this baloney about how when they get old and sick we need to let them out,” said Sandy Krasoff of Victims and Citizens Against Crime, based in Raleigh.

North Carolina, for instance, has virtually banned parole for murderers. Eason and other McCain staff members have petitioned governors for medical releases.
Against this backdrop, prisons across the country are turning to hospice care as an alternative. The first prison hospice opened in 1987, when AIDS was even more of a medical crisis. Today, 19 states offer hospice care for inmates and 14 more have programs in development.

McCain administrators and inmates say the facility is taking a leading role in setting those standards. “We look out for each other. Everyone in my dorm area goes on a watch when someone is sick,” said Enoch, during one of the 41⁄2-hour treatments he gets three times a week.

A former tuberculosis sanitarium, McCain sits on a stretch of flat land in the Sandhills region of North Carolina. Fifty-foot pine trees loom over aging brick buildings, two greenhouses and a recreation yard. Walking around McCain Correctional Hospital is like walking back in time. One recent morning, crew members dressed in olive pants and white T-shirts were mowing the small lawn while another group of men where serving a lunch of corn dogs. The majority of those at McCain are either too ill or too old.

McCain houses about 330 prisoners. Nearly 40 will never be released, because they are either serving life sentences without parole or more than 20 years, known as “practical life.” One-third of McCain’s inmates are 55 or older, compared with 13 percent nationally. A walk through the hospital brings these demographics to life. McCain is a prison version of a 400-bed nursing home: 92 beds in the infirmary section and a geriatric section with four inmates to a room, sharing a single shower and toilet.

One patient, a rail-thin man named William Long, sits in bed recalling memories of his wife, children and the time he worked in South Carolina on a demolition crew. Diabetes, a weak heart and leg ulcers have ravaged his body, but his mind is still active. “You help (other inmates and) they help you; it’s nothing like you see on TV,” Long said. The 59-year-old inmate is serving two years after being convicted of assault with a deadly weapon and inflicting serious bodily injury by an Alamance County jury.

Healthwise, he admits, he has had better days, but with aid from McCain and his family, he has been able to avoid the hospital since he was sentenced to prison 18 months ago. Long will not receive hospice care, because he is not within six months of dying, but he and other inmates will benefit from hospice volunteers, who are on hand to assist with tasks, from pushing wheelchairs to wiping noses.

Eighteen inmates at McCain are serving as hospice volunteers. Their records are scrutinized for crimes and behavior while incarcerated. They also receive hours of hospice training.

Eason, a motherly woman who greets employees with courtesy titles and chats with inmates, has been at McCain nearly 24 years. She said the idea for hospice care came about after a number of patients died. Most of the patients at McCain die from cancer and end-stage liver disease.

“Their past lives were catching up with them,” she said. “The patients need some sort of alternative. We felt they need to die with dignity, like everyone else.” A group of McCain employees, ranging from the chaplain to the pharmacist to the dietician, joined with Hospice of Hope County to draft a plan. Although the hospice concept is simple no one should die in pain, or alone — putting the plan into a prison was not easy.

“The thought was the inmates were here for punitive reasons and that they should not receive special privileges,” Eason said. Dying people often need powerful painkillers. But drugs are more likely to be abused in prison than on the
outside. At a recent conference on prison hospice in Atlanta, drug diversion was one of the most popular topics. A prison doctor from California said pain-killers were often washed out in patients’ socks. McCain inmates are never privy to pain-killers, Eason said.

Hospice patients are permitted to receive visits from prison friends, called “inmate family,” and family visiting hours are held four days a week. During a dying patient’s last 24 hours, family members are allowed to stay around the clock.

Not all dying inmates are docile, however. During the final stages of AIDS, one patient would throw bodily fluids at staff as they walked into his room. AIDS patients are kept in the general population, said Eason, and only the staff knows which prisoners have the deadly disease. Prison officials said the hospice program has not cost any extra money.

On the second floor of McCain is a remnant of the buildings days as a TB clinic a large, ornate chapel where every Sunday, Chaplain Neil Smith delivers a sermon to inmates. Many are old men who are rethinking their lives and the actions that placed them here. Many know that one of these days, a minister will preach their going-away sermon. But up until that time, Eason said, McCain’s mission is simple: “We want them to die with dignity."

http://www.thetimesnews.com