The Death Row You Haven’t Heard Of
Where California’s Prisoners Receive Humane End Of Life Care
For the thousands of prisoners who die in custody in the United States every year, life ends in basically one of two places: in a cell or in hospice. The former is most common, because the latter is extremely limited. The US has about 2,000 prisons, but only 75 in-prison hospice programs.
This disparity can be explained by simple supply and demand: prisoners are getting older while qualified staff are harder to come by, said Lisa Deal, executive director of the Humane Prison Hospice Project, whose organization trains prisoners to be hospice caregivers in a peer-to-peer support model. In order to be sustainable though, programs also need administrative buy-in at the highest level.
California Medical Facility in Vacaville, California holds one such program. Founded in response to the AIDS epidemic in 1996, it is the oldest prison hospice care program in the US. There are seventeen hospice beds at CMF, six of which are in private rooms, along a wall referred to as “death row” where patients go to actually pass away, said Fernando Murillo, who was previously incarcerated within CMF’s broader system.
Prison hospice programs typically offer peer support, chaplains, and medical services for prisoners in the last six months of their life, but what makes CMF unique is the culture shift they’ve been able to achieve.
For Murillo, there was a marked shift when he walked into X Corridor, a “pristine, white, very well-manicured, angelic” hallway, and towards the hospice center. Murillo spent the final five years of his 20-year-sentence working as a hospice caregiver, and said that when he crossed that threshold into the care facility, the hierarchies and power structures that dictate prison life dissipated. Patients and staff alike “don’t feel like they’re in prison anymore. Their humanity is prioritized,” he said.
“Normal” is the goal, said Dr. Michele DiTomas, Medical Director at CMF. “Patients are free [within the hospice facility], there are no locks on the doors. They can walk up to the nursing station, they can chat with each other, they can chat with the doctors, they can step out into the garden, they can go watch TV, they can do a puzzle with their friends.”
Caring for a dying prisoner isn’t all that different from caring for a dying free person. Over the years Murillo was trained in basic nursing functions like taking vitals, turning a patient to avoid bed sores, or changing their diapers or wound dressings. Beyond the technical stuff, he said, “what I primarily did every day was just offer my humanity to somebody that was in the most vulnerable state.
Hospice patients are open about their lives in a way prisoners usually are not, said Murillo, and veterans often share about their experiences in combat for the first time in their lives. Some of their stories are entertaining, others horrifying, he said. One of his friends—a hospice patient and veteran—told him about the worst acts of war violence he’d been in, sharing that in the midst of it, he saw “a tiger, you know, this beautiful, majestic animal, [that] appears in one of the ugliest events that humanity could possibly perpetuate.”
About 60-70 prisoners die in CMF hospice each year, said Dr. DiTomas. Each receives a memorial service where it’s not uncommon to have a line of friends waiting to share stories of the deceased. Veterans receive “the whole flag-folding ceremony to really honor their service as well,” she said.
Both Murillo and Dr. DiTomas agree that nurturing an environment of dignity and humanity for people at their most vulnerable moments is why the hospice program at CMF is so valued. That, and how cost effective the program is, said Dr. DiTomas. She described what it would look like if the program did not meet their patient’s needs. “They become stressed,” she said. “Somebody's oxygen saturation is dropping, [then] we put ‘em in an ambulance and send them to the emergency room. Not only do we incur a lot of costs from the ambulance and the custodial support and the acute care hospital and possibly the 14-day [intensive care unit] visit that the patient didn't want, but we haven't met the patient's needs either. So hospice not only gives the patient what he wants, [but] it's extremely fiscally responsible.”
Dying in hospice care also spares cellmates one of the worst events they can experience in prison, said Deal. When a prisoner dies in his cell, their cellmate is sent to solitary confinement while an investigation is conducted into the nature of the death. This is traumatic, says Deal, because cellmates can become very close, and often one will care for the other in their declining health.
“Can you imagine losing [the equivalent of] a family member and then instead of getting support for your own grief, you're sent to solitary confinement?” said Deal. “It's just horrible.”
Both medically and socially, hospice programs offer critical support to prisoners. For those who die in a cell they receive no morphine for pain management, for example. For those who die in the general prison infirmary, they are stripped of the social support they might receive in the community of their cell block or within a specialized hospice environment.
Dr. DiTomas recognizes that the carceral system was not designed with the dying in mind, which makes the role and presence of her team all the more valuable. It is a special skill set, she said, to navigate the complicated system of prison security protocols in order to bring about last wishes for her patients, whether it’s navigating the courts for compassionate release, tracking down long-lost family members, or arranging final goodbyes. In one instance, “we found their family in 24 hours when other places had been trying to do it for months.”
One goodbye was especially moving due to the unique circumstance of a dying father wishing to connect with his daughter, both of whom were incarcerated, but at separate California facilities. This was not an easy phone call to arrange.
“Our warden [is] used to us pushing the boundaries,” said Dr. DiTomas. And it paid off. The daughter was able to say goodbye to her father, albeit at a physical distance, over a 15-minute phone call, and was offered grief counseling.
“There can be some moral injury when everybody can see that [arranging the call is] probably the right thing to do, but people didn't necessarily feel empowered to make it happen. [But] by showing people that you can make that happen, hopefully… it's a culture change mechanism as well,” said Dr. DiTomas.
Few people would choose to die in prison, said Earlonne Woods, a former prisoner of California’s carceral system and host of Ear Hustle, a podcast founded by Woods during his time at San Quentin, during a live recording in Portland, Oregon. But compassionate release is difficult to arrange—patients must have somewhere to be released to, and it’s not guaranteed that family members are willing or able to take them in, said Deal. Care facilities, also, may be reluctant to accept a former prisoner.
Woods said some prisoners talk as if their freedom from prison will come before their freedom from this life. It won’t, he said, yet their peers will indulge this final form of wishful thinking.
There are organizations that act as a bridge between the supply of community hospice beds and the demand for them, like Missionaries of Charity, a California-based organization that alerts CMF of open beds at facilities that accept the formerly incarcerated, such as Gift of Love in Pacifica. But even if all the aforementioned arrangements go well, the paperwork has been known to take longer than the person has left to live.
“Death is a great equalizer,” said Murillo, “and I notice in this space that people are constantly having their consciousness challenged.”
Murillo has been out of prison since November 2020 and works at a Bay Area organization focused on changing prison culture through community health principles.
Under Dr. DiTomas’s leadership, the best practices established at CMF’s hospice program are making their way into other California carceral facilities. Her vision for the future, she said, is that everyone with an illness in prison—not only those in hospice—would receive the benefit of peer support and a companion to help them out.
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