Death in prison is not rare.
In Pennsylvania, one in 10 inmates is sentenced to life in prison. Because state law gives them no possibility of parole, nearly all of more than 5,300 inmates serving life terms will eventually die inside prison walls.
"They have no choice but to age and die in place,” said Julia Hall, a criminal justice professor and gerontologist at Drexel University.
In the Laurel Highlands prison, seven rooms are the final stop for some of the state’s sickest and oldest inmates. With breathing tubes and IVs, the mostly gray-haired inmates wait for their bodies to fail.
When their vital signs slip and they struggle for breath, other inmates hold vigil so they won’t die alone.
Sometimes death is sudden. Other times, volunteers like Christian, a 32-year-old inmate from Philadelphia, watch as life slowly slips away.
"They get to the point that they can’t talk no more,” he said. “That last breath of air they’re taking — and you’re really there holding their hands.”
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Christian, along with four other inmate volunteers, was describing his work at the hospice unit at State Correctional Institution – Laurel Highlands, a former state mental hospital that was converted in 1996 to a prison hospital for male inmates.
The facility has had a full-time hospice service for two years with room for seven inmates at a time. Previously, the hospital had a less formal system where the nursing staff tried to make inmates comfortable as they neared death.
PublicSource was granted access in August under an agreement that the last names of inmates would not be used.
Life means life
Only Florida has more inmates serving life without parole than Pennsylvania, according to a nationwide ranking of 2012 numbers by the Sentencing Project in Washington, D.C.
State law mandates life in prison for defendants convicted of first and second-degree murder.
Accomplices to murder are treated the same as a killer, even if they themselves did not cause the death. First-degree murderers can also be sentenced to death.
Repeat violent offenders can also be sentenced to life under Pennsylvania’s three-strikes law, and other inmates serve de-facto life sentences with minimums so lengthy that they will almost certainly die before release.
From 2009 through 2013, 144 lifers died in Pennsylvania, according to state statistics. Over the same period, only four inmates had life sentences commuted by the governor after unanimous recommendation by the Board of Pardons.
Since 2010, just six inmates have been granted compassionate release, which is available to inmates nearing death who meet strict criteria, according to the Department of Corrections.
‘Nobody dies alone’
At SCI – Laurel Highlands, volunteers like Christian visit patients several hours each week, playing games, helping them write letters and sometimes just keeping them company.
"Those guys need help. They don’t have no family coming to visit,” said Elvis, an inmate volunteer from Venango County.
In the seven rooms for dedicated hospice care referred to as cubes, the focus is on reducing pain, providing comfort and helping them reach out to family members.
The program is based in part on a hospice unit in California where Laurel Highlands’ former superintendent sent Annette Kowalewski, a corrections healthcare administrator, and Paula Sroka, a quality improvement nurse.
In August, the hospice rooms were full until a 68-year-old inmate died after declining treatment for liver disease and lung cancer.
Medical staff are responsible for all the patients’ health care, while inmates provide companionship and physical help such as lifting patients out of bed.
Terminal illness strikes young inmates too, and a life term is not a prerequisite to dying in prison.
Special arrangements are made so family members can visit — sometimes for hours at a time — and the prison ensures that they’ll have access when the patient is dying.
If family doesn’t come, the inmates are there.
“Nobody dies alone,” Kowalewski said. “That’s our primary concern.”
Care across the state?
Christopher Oppman, director of the Bureau of Health Care Services for the Department of Corrections, said the state has adequate resources to ensure prisoners can get hospice care in infirmaries across the prison system.
But dedicated rooms for hospice care are less common outside of Laurel Highlands, so inmates at many facilities die in open wards.
"We would not be able to operate hospice on the scale that Laurel Highlands would,” Oppman said.
Staff at some facilities lack expertise in pain and symptom management, said Phyllis Taylor, a nurse and hospice expert who has previously worked as a consultant for the department.
In other words, not every prison gives the same quality of care.
"Some of the places maybe,” she said, “but not across the board.”
Taylor assisted researchers from Penn State University in a pilot program with the department to improve end-of-life care at six prisons that have high populations of aging inmates or lifers.
Staff at those prisons received specialized training to improve and standardize end-of-life care.
Currently, the corrections department is establishing best practices for prison hospice care statewide, Oppman said.
Paying until death
In Pennsylvania, inmates are classified as geriatric at 55. Common health problems are diabetes, cancer, liver disease and heart problems. Kowalewski said that an inmate who is 40 might look several decades older.
Of the roughly 5,300 geriatric inmates in Pennsylvania prisons, about 1,500 are serving life terms.
Because parole is not possible for lifers, Hall argues that the state is committed to a geriatric prison system
You’re going to keep paying until they die,” she said.
The state spent more than $35,000 for each inmate in the 2012-’13 fiscal year. The state does not keep numbers on the specific cost for inmates over 55, but costs increase as more medical care is needed.
The prison system is among the most expensive institutions in Pennsylvania, costing the state more than $2 billion this fiscal year.
At the end of September, 19 of the state’s 26 correctional institutions were at or above capacity, according to the most recent population numbers available.
Laurel Highlands, which was at 99.4 percent of capacity, costs $75 million to operate for the year.
Mark Bergstrom, executive director of the Pennsylvania Commission on Sentencing, compared parts of the facility to a nursing home.
"When you see someone who’s on oxygen or in very poor health, we’re spending a lot of money to have that person in a prison,” Bergstrom said.
The state acknowledges that the risk of reoffending drops off with age.
The department’s 2013 recidivism report said released inmates under 21 are more than twice as likely to reoffend within three years as inmates over 50. Age has a “strong negative correlation” on recidivism, the report said.
Few ways out
Rather than paying costs indefinitely, Hall advocates for more compassionate release, criticizing a system with requirements so strict that it’s almost never used.
Politicians, she said, consider compassionate release “going easy” on offenders guilty of heinous crimes.
"It’s such a joke,” Hall said.
The state’s compassionate release rules were updated as part of a broader prison reform in 2008.
Under the law, a sentencing judge has the power to release inmates only if they are near death, have a nursing or hospice facility that will take them and have shown that their needs aren’t met in prison.
Rarely do inmates qualify.
Taylor, who has assisted prisoners seeking compassionate release, said an inmate needs to be immobile and essentially “on death’s doorstep” before a discharge is considered.
Victims and prosecutors get to weigh in, and the risk to public safety is considered.
"If they’re lifers, it doesn’t happen,” Taylor said. “That’s been my experience.”
For others, paperwork may take so long that an inmate dies before a decision is made.
Taylor said the state needs a method to evaluate whether inmates should be released if they are many years into a life term and have demonstrated that they’re not a threat.
Movement to change sentencing laws for lifers has been slow, Bergstrom said, though interest in Harrisburg is greater now than 10 years ago.
But lawmakers knew about the issue then.
In 2002, a Senate resolution directed the Joint State Government Commission to form a bipartisan task force and advisory committee to study the state’s handling of geriatric and seriously-ill prisoners. The group delivered a report in 2005 about the high-cost of an aging prison population and offered potential fixes, including the possibility of parole for lifers.
Hall, who was a member of the committee, said lawmakers ignored their suggestions and made compassionate release more difficult, not less.
In 2012, the U.S. Supreme Court ruled that mandatory life sentences without parole are unconstitutional for juveniles. The Pennsylvania Supreme Court decided that ruling does not apply to inmates already serving time, and the federal Supreme Court declined to hear an appeal.
However, Bergstrom said the Supreme Court ruling might give inmates already sentenced to life as juveniles traction with the state Board of Pardons.
Decades ago, commutations were common, meaning inmates serving life without parole would be given a lesser sentence by the governor. In the 1970s, for instance, Gov. Milton Shapp commuted 251 life sentences.
But commutations have become rare since, and under a 1997 amendment to the state constitution, the state’s Board of Pardons must unanimously recommend commutation before the governor can act.
Since the rule change, Gov. Mark Schweiker commuted one sentence and Gov. Ed Rendell commuted five.
Gov. Tom Corbett has commuted none.
The governor’s office did not respond to a request for comment.
‘Don’t want him to go’
With few ways out, sick inmates live their last days in facilities like Laurel Highlands.
The prison looks like a hospital, but with razor wire out front and vertical bars in the hallways. Patients sit in wheelchairs, breathing bottled oxygen and numbly stare into the distance.
Watching prisoners die has given the inmate volunteers perspective on their own lives and made them think about what it would mean to live the rest of their days — and die — in prison.
"I don’t think that people on the outside really understand what it’s like for a person to die in prison,” said Travis, a volunteer who was at Laurel Highlands and is now out on parole.
Among the men in hospice care at Laurel Highlands is a 96-year-old inmate named Simon — the oldest inmate in the Pennsylvania prison system.
He’s built relationships with the volunteers, and they’ve watched his health slip as he moved into hospice care.
"I don’t want him to go,” Elvis said. “He’s like a grandpa to me.”
Reach Jeffrey Benzing at 412-315-0265 or at jbenzing@publicsource.org. Follow him on Twitter @jabenzing.
