Federal prisoner with terminal illness granted parole on compassionate grounds to die outside of jail

By Mitchell Consky

Ed Speidel

A terminally ill federal prisoner, who has been fighting for a compassionate release to die outside of jail, has been granted day parole.

Ed Speidel, a 62-year old prisoner with a terminal lung disease, will be permitted to enter a secure home with round-the-clock medical assistance, his lawyer told CTV News in an email.

Speidel suffers from end-stage chronic obstructive pulmonary disorder (COPD) along with rheumatoid arthritis, and medical tests show his lungs have only 19 per cent function compared to healthy adults.

In July, Speidel spoke about his fear of dying behind bars.

“My biggest fear is dying in jail. I don’t want to die in jail,” Speidel told CTV News in a phone interview, from an office in the Matsqui Institution, a medium-security prison in Abbotsford, B.C.

In July of 2022, Speidel, who has served a total of 41 years in prison requested parole by exception – also known as compassionate or geriatric parole — at a hearing, but his request was rejected.

This year, he obtained legal support and worked on an application for medically assisted death.

Speidel told CTV News that he was arrested for robberies and never hurt any one.

With more than 1,700 (25.6 per cent) prisoners in federal jails 50 years old and older, Speidel is one example of aging offenders increasingly susceptible to life-threatening health risks.

Lisa Crossley, who works with Prisoner Legal Services in Vancouver, told CTV News in July she thinks more options should be provided to terminally ill prisoners.

“For the vast majority of people, if you are terminally ill, what risks do you really pose? I think that should be asked and there should be more options for people for some type of release,” Crossley said.

“It is a matter of public importance that affects many people in federal prison.”

Complete Article HERE!

Incarcerated Seniors Lack Access to Hospice Care

By Holly Vossel

Aging, incarcerated populations often have poor end-of-life care experiences, with a lack of trained hospice workers at the crux of the issue.

The end -of-life experience looks very different for seniors in prison, with many lacking access to support around the most basic human needs, according to David Garlock, a national public speaker. He is a formerly incarcerated criminal justice reform advocate and reentry expert.

“It’s terrible how many men and women are experiencing their last days or hours of life in prison,” Garlock told Hospice News. “Imagine you’re dying, laying in a bed you can’t get up from without any human contact for several hours in a day. I don’t think there are enough hospice programs in prisons around the country. A lot of times these programs are run by the incarcerated men and women, with nurses and doctors having a very small part in taking care of them.”

Garlock previously provided prison-based hospice care to fellow incarcerated individuals at the Kilby Correctional Facility, part of the Alabama Department of Corrections system. He currently speaks on health equity among prison populations.

Quality issues are tied to a limited supply of clinicians who are trained to provide hospice care in prison settings, Garlock indicated.

Not only do clinicians have limited windows of time at the bedside with incarcerated patients, but they also may not be able to provide the full scope of interdisciplinary services involved – including basic comfort and pain management, he stated.

Incarcerated hospice caregivers must abide by certain rules and processes when it comes to providing others with assistance, depending on the prison, Garlock explained. This means they can be limited in providing end-of-life care support with things such as changing sheets or diapers, bathing or moving the dying person, he stated.

“These are things that you technically had to have a nurse present to do in many cases,” Garlock said. “But it really depends on nurses as far as how much they could do, too. There were certain times they’d lack just doing the basics for people. In some prisons, they have only a couple areas and limited beds for people on hospice could go. It’s also just not having nurses who are trained specifically for hospice care in prison settings. I think what’s necessary is having at least one hospice person at every prison to provide the necessary care that incarcerated people can’t provide or aren’t supposed to do.”

Few prisons in the United States have hospice programs that are well-staffed, according to Lisa Deal, executive director of the Humane Prison Hospice Project. The California-based humanitarian organization helps train incarcerated peer caregivers in providing end-of-life care support.

Part of the understaffing issues is that geriatric populations are swelling “dramatically” in prison settings, with more seniors facing the end of life behind bars without access to hospice services, Deal stated.

Seniors 55 and older represented 15% of the state and federal prison population in 2021, swelling five times past 3% in 1991, according to a report from the Prison Policy Initiative.

Widespread workforce shortages have hospices grappling with the ability to spread strained clinical staffing resources among prison populations, Deal said.

“What’s really at the root of humane hospice in prison is just trying to train these peer caregivers as hospice providers face competing demands for their care in the outside world,” Deal told Hospice News. “It’s about increasing access to care and being able to expand these training programs using caregivers who are really focused on the needs of folks at the end of life in prison.”

Providing caregiver training among incarcerated individuals can increase access to hospice and improve quality outcomes, she indicated. An important part of this training is familiarizing peer caregivers with the nature of hospice care and how this support differs in prison systems compared to other settings, Deal said.

Serious and terminal illnesses can have very different trajectories among incarcerated seniors, especially for those with mental health and addiction issues that can require additional care and support, she stated.

Dementia, trauma and chronic stress are the most common health issues among much of the country’s prison population, the National Institute of Corrections reported. More than 3,000 individuals with these conditions die annually in prison.

“We tend to see people age faster with more physiological and medical needs when they’re behind bars,” Deal said. “Training caregivers can provide a lot of hands-on care alongside nurses, and it can be very tailored towards prison populations that often have very traumatic experiences around death.”

In addition to expanded training, more investment is needed to build structural support systems for dying incarcerated individuals, according to Garlock.

“More money is needed for hospice support behind bars to where it can provide some sort of comfort and peace to dying people,” Garlock said. “Hospices also really need a better understanding of who these people are, what abuses they may have endured and how to help them cope with those experiences. It’s taking risks to take care of these people. Someone on their deathbed isn’t much of a threat to society.”

Complete Article HERE!

Hospice in Prison Part 2

— An interview with the Pastoral Care Workers

I don’t know ’bout religion
I only know what I see
And in the end when I hold their hand
It’s both of us set free

These are the ending lyrics to Bonnie Raitt’s song “Down the Hall”, an ode to the Pastoral Care Workers who care for their fellow inmates in the hospice unit at the California Medical Facility in Vacaville, California. On last week’s podcast we interviewed the medical director and the chaplain of the prison’s hospice unit (Hospice in Prison Part 1). This week we turn our attention to the inmates.

Pastoral Care Workers are inmates who volunteer time to care for the dying who come from all around California to spend their last days, weeks or months in the prison’s hospice unit, fulfilling a mission that “no prisoner dies alone.”

On today’s podcast we talk with three of these Pastoral Care Workers, Jerry Judson, Jeffrey Maria, and Allan Krenitzky. We discuss with them why they decided to volunteer for the hospice unit, what a day in the life of a Pastoral Care Worker looks like, and among other things their thoughts on forgiveness, redemption, rehabilitation, and compassionate release.

We also had the pleasure to take a walk through the hospice unit garden with Mr. Gerald Hite. He taught us a little about the different flowers and plants, and along the way a little about why he does what he does.

While this is a podcast about volunteers in a prison hospice, I think it also serves as a lesson for us all about how we make meaning to our own lives and define ourselves by not only what we have done in the past, but what we do now. One story that Allen told perfectly sums this up. He said one day his son asked his wife what he does for a living, and his wife said “Papa helps sick people.”

Complete Article HERE!

Hospice in Prison Part 1

— An interview with Michele DiTomas and Keith Knauf

In the early 1990’s, California Medical Facility (CMF) created one of the nation’s first licensed hospice units inside a prison. This 17-bed unit serves inmates from all over the state who are approaching the end of their lives. A few are let out early on compassionate release. Many are there until they die.

Today’s podcast is part one of a two-part podcast where we spend a day at CMF, a medium security prison located about halfway between San Francisco and Sacramento, and the hospice unit housed inside its walls.

We start off part one by interviewing Michele DiTomas, who has been the longstanding Medical Director of the Hospice unit and currently is also the Chief Medical Executive for the Palliative care Initiative with the California Correctional Healthcare Services. We talk about the history of the hospice unit, including how it was initially set up to care for young men dying of AIDS, but now cares for a very different demographic – the rapidly aging prison population. We also talk about the eligibility for the unit, what makes it run including the interdisciplinary team and the inmate peer workers, and the topic of compassionate release.

Afterwards, we chat with the prison’s chaplain, Keith Knauf. Keith per many reports, is the heart and sole of the hospice unit and oversees the Pastoral Care Workers. These are inmates that volunteer to work in the hospice unit, serving a mission that “no prisoner dies alone.” We chat with Keith about how hospice in prison is different and similar to community hospice work, the selection process and role of the peer support workers, the role of forgiveness and spirituality in the care of dying inmates, and what makes this work both rewarding and hard.

Part two of the podcast, which comes next week, is solely focused on the Pastoral Care Workers. We interview three of them in the hospice unit and take a little tour of the hospice gardens.

Complete Article HERE!

Dementia in Prison Is Turning into an Epidemic

— The U.S. Penal System Is Badly Unprepared

Older prisoners will make up a third of the prison population in a decade, and many of them will develop dementia

By Sara Novak

Terrell Carter remembers one prisoner in particular. They had both been seeking commutations of their life sentence so they could eventually apply for parole. But Carter says that in the midst of the process, his fellow inmate became so debilitated with dementia that the man could no longer function well enough to complete the paperwork.

Within a few months, Carter says, this prisoner was incapacitated, lying in bed with arms outstretched over his head, calling for help. Carter, an inmate who volunteered in the hospice ward of State Correctional Institution Phoenix in Collegeville, Penn., says that his fellow prisoner languished and eventually perished in prison because he was too mentally impaired to file for forgiveness. “By the end, he didn’t know the crime he was charged with committing,” Carter says

In the October 2021 issue of Northwestern University Law Review, Carter, along with Drexel University associate professor of law Rachel López, argue that the current sentencing structure all too often locks people up and throws away the key. A former commissioner on Pennsylvania’s sentencing board, López is especially concerned with the number of elderly people who are incarcerated. “It’s all part of the legacy of the ‘tough on crime’ era,” she says.

A survey by the Pew Charitable Trusts found that the number of inmates age 55 or older increased by 280 percent from 1999 to 2016. Three-strikes laws and mandatory life sentences without the possibility of parole expanded during the 1980s and 1990s, and many of these laws are still on the books today. As the number of aging prisoners balloons, so, too, do instances of dementia. An article López authored in the June 2020 issue of Federal Sentencing Reporter projected that between 70,341 and 211,020 of the estimated 400,000 incarcerated elderly in 2030 will develop dementia. Alzheimer’s disease is the most common diagnosis, but dementias that involve Lewy bodies, the vascular system and Parkinson’s disease are also on the list.

Prison may also accelerate aging and the possibility of developing the disease, according to a January 2022 article published in the journal Health & Justice. Study author Bryce Stoliker, a researcher at the University of Saskatchewan, says that the high risk is because of challenges faced in prison life—and inmates’ experiences before incarceration. Prisoners are often marginalized members of society with less access to health care, poorer diet, issues with alcohol or drug misuse, mental health problems and potential traumatic brain injuries—all factors that increase the likelihood of developing the condition. “Once behind bars, a lack of stimulation and an overall poor quality of life magnifies the problem,” Stoliker says.

Prisoners with dementia are also vulnerable to abuse. Their erratic behavior and inability to follow directions is aggravating to other prisoners and to the staff in an already tense and sometimes violent environment, says Tina Maschi, co-author of the book Aging Behind Prison Walls: Studies in Trauma and Resilience.

A 2012 study she authored in the Gerontologist found that those with dementia are increasingly vulnerable to “victimization.” If they become aggressive toward staff or can’t stay in line, they’re more likely to be reprimanded. “They’re no longer in touch with the prison rules, and as a result, it appears to staff, who often aren’t trained in dealing with dementia patients, that they’re acting out,” Maschi says. Additionally, according to the study, they can become victims of sexual assault by other prisoners because they can’t defend themselves.

With strict sentencing practices still in place, the problem could get worse. The American Civil Liberties Union projects that in a decade, prisoners age 55 and older will make up one third of the U.S. incarcerated population. And prisons, López says, don’t have the resources to tend to this highly vulnerable population. Still, there may be some relatively available short-term solutions. Older prisoners are often housed together, but senior structured living programs that include daily stimulation such as puzzles, knitting and cognitive exercises may help to reduce the risk of elderly prisoners who get dementia later on.

True Grit, a program at Northern Nevada Correctional Center, is described in a review published in the December 2019 issue of Health & Justice. It teaches inmates older than age 55 skills such as latch rug making, crocheting, painting, jigsaw puzzle making and beading, as well as emphasizing the importance of physical exercise. The program has been shown to increase inmate quality of life, reduce medication use and behavioral problems, and enhance overall health and well-being.

Compassionate release is another tool that is largely underutilized, according to experts. Also called “geriatric parole,” it’s currently used once patients get to the end of their life. But for the program to reduce the elderly burden on the prison system, it would have to be used before inmates are so ill that they can no longer be integrated back into society. Once prisoners are too far gone, says Ronald Aday, author of the book Aging Prisoners: Crisis in American Corrections, it’s much harder for them to find “a place to land” outside of prison, and nursing homes are unlikely to admit a felon. Still, a 2018 report from Families Against Mandatory Minimums (FAMM) found that the program is rarely used and that, in many states, it presents aging inmates with a troubling “number of barriers” to getting out.

When inmates do develop dementia, prison workers, at a minimum, need to be provided with basic training to deal with the disease. “Correctional staff and those in direct daily contact with older prisoners need to understand both their vulnerability to other inmates and their inability to understand orders,” Aday says.

Looking ahead, dementia wards in prison may be needed to house prisoners with cognitive problems. One such memory ward opened in 2019 at Federal Medical Center Devens in Massachusetts. The facility staff is specially trained to take care of those with dementia.

But building dementia wards in prisons shines a spotlight on a larger issue: prisons are not properly equipped to house these patients because this was never their purpose in the first place. “The original intent of prison was to rehabilitate,” Aday says. “Correctional institutes were meant to ‘correct people’ so they could go back out and work.” Somewhere along the way, he adds, we’ve lost our purpose, and as a result, 10-year sentences have tripled, and life in prison without the possibility of parole is all too common. If we don’t get ahold of our out-of-balance sentencing structure, Aday says, we’ll never be able to really address the issue.

Carter, now age 53, feels lucky that he made it out “by the skin of his teeth.” After graduating from Villanova University and spending years taking care of elderly inmates, he was able to commute his sentence to life with parole for a robbery that he says went terribly wrong when he was 22 years old. Last July he was released after spending three decades in maximum-security prison.

Still, Carter is haunted by those he left behind, especially in the hospice ward. He says by the end of their life, most of them don’t even realize where they are, let alone what got them there. “You gotta wonder what kind of punishment it is if you don’t even know you’re in prison,” Carter says.

Complete Article HERE!

End-of-life policies vary in United States prisons

There is significant variability in state- and nationwide policies on end-of-life decision making in United States prisons, a review finds.

“…the Federal Bureau of Prisons policy states that DNRs should not be followed if the individual is part of a prison’s general population,” says Victoria Helmly.

by

The findings show significant variability regarding which incarcerated patients can complete advance care planning documents, how they are granted access to document their end-of-life wishes, and who can serve as their surrogate decision-makers.

There is an urgent need for geriatric and end-of-life care in US prisons. The prison population is aging rapidly, and older adults make up the fastest-growing age demographic among incarcerated individuals. The majority of deaths in prison are due to illness, and older adults account for the largest percentage of prison deaths.

“During the 1980s and 1990s, ‘tough on crime‘ laws produced an increase in very long prison sentences, and as a result we are seeing more people remain in prison into older adulthood,” says Victoria Helmly, a doctoral student in the Georgia State University criminal justice and criminology department. “In addition, more people are entering prison at an older age.”

End-of-life in prison

According to standards set by the National Commission on Correctional Health Care, incarcerated individuals have the right to make end-of-life care decisions. These advance directives commonly include health care power of attorney (in which another individual is empowered to make decisions about their medical care) and “do not resuscitate” (DNR) orders or other directives regarding medical interventions or advanced life support. However, as the study notes, there are multiple barriers to implementing advance care planning in prisons, such as finding a person to serve as a health care power of attorney.

The researchers pulled 36 state-level policies as well as policies from the Federal Bureau of Prisons. They found that 22% of policies state that advance directive documents are offered when a person first enters the prison facility, regardless of age or health status. (Others indicate that end-of-life documents are discussed during medical exams.) More than a third (38%) of policies make no mention of where advance directives are located or when incarcerated individuals should be given the opportunity to complete them.

According to the study, most policies do not state who is eligible to complete advance directives. However, the researchers found notable exceptions. For example, three states (Hawaii, Maine, and Massachusetts) only allow those with terminal illness to complete an advance directive.

Health care proxies

The policies also differed in their approach to who is empowered to act as a health care proxy (i.e. make health care decisions on behalf of patients). Of the policies, 80% do not allow other incarcerated persons to serve as health care proxies, and 60% bar prison staff from serving as proxies. Notably, Georgia is the only state whose policy explicitly allows other incarcerated people to serve as proxies. Many policies also prohibit other incarcerated people (45%) or correctional staff or health care providers (41%) from serving as witnesses to advance directive documentation.

The researchers note that these restrictions warrant further exploration, as they can make it difficult for incarcerated persons to have their end-of-life wishes honored.

“If neither other incarcerated individuals nor prison staff can serve as health care proxies, this may leave an incarcerated person without many other options,” says Helmly, lead author of the study in the International Journal of Prisoner Health.

Nearly all (95%) policies state that advance care planning documents are kept in the person’s medical record, and nearly half (49%) indicate that the documents will be transferred with the individual to a hospital or different correctional facility.

But what about compliance?

The researchers also found very little discussion of compliance. Just one state policy (Idaho) mentions a review of compliance. No policies defined quality metrics or compliance goals. In fact, some policies specifically stated that portions of advance directives do not have to be implemented.

“I was surprised to learn that some policies state that correctional staff can decline to follow DNR orders if they feel doing so would constitute a ‘security’ threat,” says Helmly. “In addition, the Federal Bureau of Prisons policy states that DNRs should not be followed if the individual is part of a prison’s general population.”

In sum, the findings suggest an important opportunity to develop national guidelines for prisons to standardize their policies in accordance with community standards.

“This would help to ensure that incarcerated people across jurisdictions have the same opportunity to document their end-of-life wishes and increase trust that those wishes will be honored,” says Helmly.

Complete Article HERE!

Perspectives on providing end-of-life care for the nation’s incarcerated

A view of the Prince Georges County Correctional Facility in Upper Marlboro MD

According to the Maryland Center for Economic Policy, the state of Maryland spends about $1 billion per year incarcerating roughly 20,000 people convicted of crimes. A third of them come from the city of Baltimore. In 2015, our state spent $17 million locking up people from one neighborhood alone: Sandtown-Winchester in West Baltimore.

For many of those who are given long sentences, their lives end while they are behind bars. An essay in the Baltimore Sun a couple of months ago about palliative care for prisoners when they are diagnosed with terminal illnesses caught our attention, and today, we’d like to explore the issue of death with dignity for those who are imprisoned.

Tom’s first guest is Dr. Raya Elfadel Kheirbek. She is the author of the essay mentioned above, and the Chief of the Division of Geriatrics and Palliative Medicine at the University of MD.

Dr. Kheirbek joins us on Zoom.

Then, Tom is joined by three activists working with an organization called the Humane Prison Hospice Project:

LadyBird Morgan is a registered nurse and the co-founder, and program director of the Project. She joins us on Zoom…

Marvin Mutch is a Senior Advisor and policy advocate for the Project. He also joins us on Zoom…

And Edgar Barens joins us as well via Zoom. He serves as an advisor to the Humane Prison Hospice Project. He’s a filmmaker whose 2014 documentary called Prison Terminal was nominated for an Academy Award.

Morgan_Mutch_Barens_COMBO_.png
(from left) Humane Prison Hospice Project co-founder and program director Ladybird Morgan, RN, MSW; Marvin Mutch, former inmate and special advisor; filmmaker Edgar Barens, producer of the 2014 documentary “Prison Terminal.”

Complete Article HERE!