Prisons routinely ignore guidelines on dying inmates’ end-of-life choices

By Renuka Rayasam KFF Medical News Brian Rigsby was lying with his right wrist shackled to a hospital bed in Montgomery Alabama when he learned he didn t have long to live It was September and Rigsby had been brought to Jackson Hospital from an Alabama state prison days earlier after complaining of pain and swelling in his abdomen Doctors located that untreated hepatitis C had caused irreversible damage to Rigsby s liver according to his healthcare records Rigsby decided to stop efforts to treat his illness and to decline lifesaving care a decision he made with his parents And Rigsby s mother Pamela Moser tried to get her son circulated to hospice care through Alabama s physiological furlough program so that their family could manage his end-of-life care as they saw fit But there wasn t enough time for the furlough request to be considered After learning that Rigsby was on palliative care the staff at YesCare a private prison healthcare company that has a billion contract with the Alabama Department of Corrections recounted the hospital it would stop paying for his stay and then transferred him back to Staton Correctional Facility in Elmore according to the hospital record his mom provided to KFF Physical condition News Moser never saw or spoke to her son again The last day I went to see him in the hospital I was hoping he would take his last breath mentioned Moser a former hospice nurse That is how bad I didn t want him to go to the infirmary at the prison A week later Rigsby died of liver failure in the infirmary according to his autopsy assessment Pamela Moser holds a photo of her son Brian Rigsby who died while incarcerated in an Alabama state prison Tamika Moore KFF Medical News TNS Pamela Moser a former hospice nurse unveiled out her son Brian Rigsby was terminally ill in September while he was incarcerated in Alabama He died the next month But she says she has no idea whether he spent his last days in pain or peace because prison executives would not let her see or speak to him Tamika Moore KFF Robustness News TNS Pamela Moser has photos taken by her son Brian Rigsby hanging in her home Tamika Moore KFF Physical condition News TNS Pamela Moser got her dog Cece three weeks after the death of her son Brian Rigsby in the infirmary of Alabama s Staton Correctional Facility Tamika Moore KFF Vitality News TNS Pamela Moser s son Brian Rigsby spent his final days in the infirmary of Alabama s Staton Correctional Facility where he died Tamika Moore KFF Wellbeing News TNS Pamela Moser outside her home in Graysville Alabama Her son Brian Rigsby died in October in a prison infirmary Moser a former hospice nurse says she was denied a say in the care he received during his final days Tamika Moore KFF Healthcare News TNS Show Caption of Pamela Moser holds a photo of her son Brian Rigsby who died while incarcerated in an Alabama state prison Tamika Moore KFF Fitness News TNS Expand Personnel at the corrections department and YesCare did not respond to requests for comment As the country s incarcerated population ages rapidly thousands die behind bars each year For specific researchers medicinal providers and families of terminally ill people in custody Rigsby s situation and Moser s frustration are familiar Incarcerated people typically have little say over the care they receive at the end of their lives That s despite a broad consensus among standards boards policymakers and robustness care providers that terminally ill people in custody should receive remedy that minimizes suffering and allows them to be actively involved in care planning But such guidelines aren t binding State policies on end-of-life care vary widely and they generally give much leeway to correctional officers according to a review led by Georgia State University The upshot is that correctional officers and health contractors make the decisions and they focus more on assurance concerns than easing the emotional spiritual and physical pain of the dying say researchers and families People in jails and prisons often die while shackled to beds separated from loved ones and with minimal pain medication reported Nicole Mushero a geriatrician at Boston University s Chobanian Avedisian School of Medicine who studies and works with incarcerated patients When you re coming at this from a strength care perspective it s kind of shocking Mushero reported Measure vs Autonomy Patients are often suspended or dropped from their healthcare coverage including commercial insurance or Medicaid when incarcerated Jails and prisons have their own systems for providing physical condition care often funded by state and local budgets and therefore aren t subject to the same oversight as other populace or private systems The National Commission on Correctional Fitness Care which accredits programs at correctional facilities across the country says terminally ill people in custody should be allowed to make decisions about cure options such as whether to accept life-sustaining care and appoint a person who can make physiological decisions for them Jails and prisons should also provide patients with pain medication that wouldn t otherwise be available to them allow extra visits with loved ones and consider them for curative release programs that let them receive hospice care in their communities disclosed Amy Panagopoulos vice president of accreditation at the commission That approach is often at odds with safeguard and safety rules of jails and prisons so facility leaders may be heavily involved in care decisions she commented As a aftermath the commission plans to release updated standards this summer to provide more details on how facilities should handle end-of-life care to ensure incarcerated patients are more involved in the process Related Articles Astronaut one day artist the next How to help children explore the world of careers Even where abortion is still legal a large number of brick-and-mortar clinics are closing American Beverage Association challenges Santa Cruz soda tax with lawsuit One-time California drug rehab mogul faces federal criminal charges One of the the greater part contagious diseases Bay Area wellness administrators warn about viable measles exposure State laws on therapeutic decision-making informed consent and person privacy apply even to incarcerated patients revealed Gregory Dober who teaches biomedical ethics and is a prison monitor with the Pennsylvania Prison Society a nonprofit that supports incarcerated patients and their families But correctional officers and their curative contractors often prioritize safeguard instead Dober disclosed The Federal Bureau of Prisons allows guards to override do-not-resuscitate orders if they interfere with the shield and orderly operation of the institution according to the agency s individual care guide This is a wildly understudied area revealed Ben Parks who teaches curative ethics at Mercy College of Ohio In the end it s all about the state control of a prisoner s life About a third of all people who died in federal custody between and had a do-not-resuscitate order according to Bureau of Prisons evidence obtained by KFF Soundness News through a Freedom of Information Act request The prison bureau s initiative of forcing CPR on patients is cruel Parks revealed CPR can break ribs and bruise organs with a low likelihood of success That is why people sign do-not-resuscitate orders refusing the remedy he reported This is the inversion of the death penalty Parks announced Resuscitation against your will Cut Off From Family In addition corrections personnel decide whether and when to reach out to a victim s friends or relatives revealed Erin Kitt-Lewis a Penn State College of Nursing associate research professor who has studied the care of older adults in prisons As a consequence terminally ill people in custody often can t involve their families in end-of-life care decisions That was the incident for Adam Spurgeon who was incarcerated in a state prison in Tennessee his mother declared One morning in November Kathy Spurgeon got a call from hospital administrators in Nashville saying her son had only hours to live she mentioned About a month earlier she had learned from her son that he had had heart surgery and developed an infection she reported But she didn t know much about his recovery Around noon she arrived at the hospital about a three-hour drive west of where she lives Adam died that evening Dorinda Carter communications director at the Tennessee Department of Correction declined to comment on Spurgeon s development It is our protocol to not comment on an individual inmate s diagnostic care she revealed in an email Kathy Spurgeon commented providers who treated Adam outside of prison were too deferential to guards And physicians who work with incarcerated patients say that can be the event Even when terminally ill people in custody are treated at hospitals correctional officers still end up dictating the terms of care Hospital staff members often don t understand the rights of incarcerated patients and are unsure about state laws and hospital policies declared Pria Anand a neurologist who has treated incarcerated patients in hospitals The biggest difficulty is uncertainty she commented Correctional officers sometimes tell hospital staffers they can t contact next of kin for prevention reasons or they won t tell a case about discharge plans because of worries they might escape Anand stated And care frequently takes place within prisons which often are not equipped to handle the complexities of hospice decision-making including types of therapy when to stop healing and who can make those decisions reported Laura Musselman director of communications at the Humane Prison Hospice Project which provides training and training to improve end-of-life care for incarcerated patients Our prison system was not designed to provide care for anyone especially not people who are chronically ill terminally ill older actively dying noted Musselman who noted that her group s training has modules to cover all aspects of end-of-life care including grief assistance hands-on caregiving and paperwork Rigsby struggled with mental physical condition and addiction for greater part of his adult life including a stint in prison for a drug-related robbery A parole violation in landed him back in prison At Jackson Hospital Rigsby was given hydromorphone a powerful pain medication as well as the anxiety drug lorazepam Before he was transferred back to prison a nurse with YesCare one of the country s biggest prison vitality care providers which has been sued over substandard care assured hospital staffers he would be provided with the same level of pain medication and oxygen he had received at the hospital his medicinal records show But Moser announced she doesn t know whether he spent his last days in pain or peace The state wouldn t provide Moser with Rigsby s health records from the prison she declared She explained she wasn t allowed to visit her son in the infirmary and wasn t stated why Moser called the infirmary to comfort her son before his death but staffers recounted her he couldn t make it to the phone and they couldn t take one to him she noted Instead Moser reported she left messages for prison bureaucrats to tell her son she loved him It breaks my heart that he could not talk with his mother during his last days commented Moser whose son died on Oct Two weeks later she drove to Woodstock Alabama to collect his remains from a crematorium KFF Healthcare News statistics editor Holly K Hacker contributed to this analysis KFF Robustness News Distributed by Tribune Content Agency LLC