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Convicted Murderers Relearn Compassion in Prison Hospice

Oregon: With the spread of tough sentencing laws and HIV, more inmates are dying behind bars. When other prisoners volunteer to ease their last days, everyone benefits.


SALEM, Ore. — The first time Harvey Caron went to prison--seven years in a federal pen for flying marijuana out of Mexico--he spent all his spare time in the weight room. When he had done his time, he walked out bigger and badder, with a serious attitude.

When a cocaine deal in Roseburg went bad and he killed a man, Caron, 45, copped a plea on a reduced charge of murder and ended up here, in the Oregon State Penitentiary, for a life sentence rather than take a chance on death row.

Instead of going to the weight room each day when he's done with his prison job, he comes to the infirmary to pump himself up in a different way--helping a fellow lifer face a death sentence imposed by neither judge nor jury.

Caron is one of the 19 inmates--all but three of them convicted killers--who have volunteered to care for the dying in the prison hospice. His focus in life right now is to help Lou Miller, a convicted murderer himself, die with dignity from a brain tumor.

"I can't change what I did," Caron said through his heavy red mustache. "All I can do is live my life the best I can.

"I hope I make Lou's last part of his life a little easier. Hopefully, I will get out of prison. If I don't, I hope somebody up here will be doing it for me."

With the spread of tougher sentencing laws and HIV, prisons around the country are dealing with more inmates who will die behind bars, according to a 1998 National Institute of Corrections report, "Hospice and Palliative Care in Prisons." More than 800 inmates around the country were terminally ill in 1998.

Oregon alone expects 800 inmates to die behind bars over the next 45 years.

"A lot of these people don't have any family who want to see them," said William Cahall, health services manager at the state penitentiary. "They may have alienated their families, or their families are not alive. This is our way of making sure they don't die alone."

Indeed, dying without family or friends is one of an inmate's greatest fears, said Tanya Tillman, hospice case manager at Louisiana State Penitentiary in Angola.

Since Oregon voters enacted tougher mandatory sentences for violent crimes in 1994, Cahall noticed an increasing number of deaths in Oregon prisons. After bouncing between six and 15 a year in the late 1980s and early 1990s, the numbers spiked to 25 in 1996 and 19 in 1997.

With a mandate to provide medical care at the same level as outside the prison, Cahall put together a committee that looked at prison hospices around the country and created one here last April.

That community standard puts a wrinkle in caring for terminally ill patients in Oregon, where they can ask a physician to prescribe a lethal dose of medication under the assisted suicide law. The Department of Corrections is not looking forward to the day it is confronted with such a request.

"We have to be very careful with any request that we get," said health services administrator Catherine Knox. "The hardest hurdle to cross . . . is the extent to which the [patient's] decision has to be free of the conditions of incarceration. If a person is choosing suicide because of incarceration, I don't believe you could make the statute apply."

Since inmates at the Federal Bureau of Prisons medical facility in Springfield, Mo., created the first prison hospice in 1987, the program has spread around the country. Besides Oregon, there are programs in California, Colorado, Illinois, Louisiana, Maryland, Missouri, New York, North Carolina, Pennsylvania, South Carolina and Texas. Twelve other states are considering them, and South Carolina and Louisiana are expanding.

"Hospice is a philosophy," said Cahall. "The medical care doesn't really change. It basically means you have accepted that you have a terminal illness. You are not going to be seeking curative treatment. Nearly all your treatment will be pain control."

That means inmates in hospice generally sign a "Do Not Resuscitate" order. Many prisons also bend the rules so families and volunteers can spend more time with dying inmates.

Briseldo Escobedo, 23, of Medford, became the first Oregon inmate to die in hospice in June. His family tried to bring him home to die, but the parole board refused after the mother of the man he had killed objected.

With hospice, his last days dying of cancer were spent with his family and inmate volunteers around him. Using a special pump, he was able to give himself as much morphine intravenously as he needed to control his pain.

The most profound impact may be on the inmates who care for the dying. At the Texas Department of Corrections medical unit, the prison saw the number of violent episodes drop dramatically once they created a hospice with inmates caring for the dying, said Dr. Jason Calhoun, the department's medical director of managed care.

"I don't really understand why," Calhoun said. "It just changed how that inmate population dealt with security."

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