ANGOLA, La. — Robert Newman, an inmate at the Louisiana State Penitentiary here, shifts uncomfortably in his bed, fighting nausea and fatigue. At 46, he is gaunt and dying. AIDS has gutted his immune system. Hepatitis C has wrecked his liver.
Prison is a tough place to die, yet Newman's plight is not as grim as it once might have been. Three years ago, Angola, as the prison is called, opened a hospice. Newman, who is serving a 50-year sentence for robbing banks and supermarkets, is the 42nd patient.
He sleeps in a real hospital bed, a big step up from his old metal cot. His cell in the infirmary has an "open-door policy," which means the guards let him meander outside, to a fenced-in yard, if he has the strength. One day not long ago, Newman wished aloud for Raisin Bran. The next day, some appeared in his cell.
And unlike prisoners here in the past, Newman will not die alone. His fellow inmates, trained in hospice care, watch over him.
The hospice at Angola is a new answer to a pressing question in prisons: what to do with dying inmates.
Longer mandatory sentences, tough law-and-order policies that keep criminals behind bars even when they are physically no longer a threat to others, and a quadrupling of the nation's prison population over two decades, have led to more dying prisoners. At the same time, the inmate population is becoming more middle-aged, so wardens envision a future of caring for more of the infirm. Inmate deaths rose to 3,029 in 1999 from 727 in 1980, according Justice Department figures.
In response, some prison officials, including Angola's warden, Burl Cain, advocate compassionate release, or medical parole. But victims' rights advocates counter that violent criminals, even feeble ones, should remain behind bars.
Against this backdrop, prisons across the country are increasingly turning to hospices as a humane alternative. The first prison hospices opened in 1987, when AIDS was even more of a medical crisis. Today, 19 states offer hospice care for inmates and 14 have programs in development, according to the Volunteers of America, a nonprofit social services agency that is writing standards for the care of inmates nearing death.
"What is happening is quite remarkable, against all odds," said Dr. Ira Byock, who directs a program, financed by the Robert Wood Johnson Foundation, to improve care of the dying. Byock visited the Oregon State Penitentiary hospice, which, like Angola, relies on inmate volunteers. "What has emerged," he said, "is a commitment to one another, a human community."
The same might be said of Angola. Hospice volunteers say the program has transformed their lives. "I've bathed people . . . I've asked men if it's time to put on a diaper," said James West, a 45-year-old armed robber who helps lead the volunteer corps. "If God does keep books, I hope he keeps books on what I'm doing now."