Introduction to the Issue
By Renuka Rayasam, KFF Health 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 2023, and Rigsby, 46, had been brought to Jackson Hospital from an Alabama state prison 10 days earlier after complaining of pain and swelling in his abdomen. Doctors found that untreated hepatitis C had caused irreversible damage to Rigsby’s liver, according to his medical records.
The Struggle for End-of-Life Care
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 released to hospice care through Alabama’s medical furlough policy, 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 health company that has a $1 billion contract with the Alabama Department of Corrections, told 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 Health 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,” said 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 report.
The Challenges of End-of-Life Care in Prisons
As the country’s incarcerated population ages rapidly, thousands die behind bars each year. For some researchers, medical 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 health care providers that terminally ill people in custody should receive treatment that minimizes suffering and allows them to be actively involved in care planning.
Security vs. Autonomy
Patients are often suspended or dropped from their health coverage, including commercial insurance or Medicaid, when incarcerated. Jails and prisons have their own systems for providing health care, often funded by state and local budgets, and therefore aren’t subject to the same oversight as other public or private systems. The National Commission on Correctional Health Care, which accredits programs at correctional facilities across the country, says terminally ill people in custody should be allowed to make decisions about treatment options, such as whether to accept life-sustaining care, and appoint a person who can make medical decisions for them.
Cut Off From Family
In addition, corrections officials decide whether and when to reach out to a patient’s friends or relatives, said Erin Kitt-Lewis, a Penn State College of Nursing associate research professor who has studied the care of older adults in prisons. As a result, terminally ill people in custody often can’t involve their families in end-of-life care decisions. That was the case for Adam Spurgeon, who was incarcerated in a state prison in Tennessee, his mother said. One morning in November 2018, Kathy Spurgeon got a call from hospital officials in Nashville saying her son had only hours to live, she said.
Conclusion
The issue of end-of-life care in prisons is complex and multifaceted. While there are guidelines and standards in place for providing care to terminally ill inmates, these are often ignored or overridden by security concerns. The result is that many inmates die in prison, often in pain and without the support of their loved ones. It is essential that we prioritize the humane treatment of all individuals, including those who are incarcerated, and work to ensure that they receive the care and dignity they deserve at the end of their lives.
FAQs
Q: What happens to an inmate’s health coverage when they are incarcerated?
A: Patients are often suspended or dropped from their health coverage, including commercial insurance or Medicaid, when incarcerated.
Q: Can inmates make decisions about their end-of-life care?
A: The National Commission on Correctional Health Care says terminally ill people in custody should be allowed to make decisions about treatment options, but this is often not the case in practice.
Q: Can families be involved in end-of-life care decisions for incarcerated loved ones?
A: Corrections officials decide whether and when to reach out to a patient’s friends or relatives, and terminally ill people in custody often can’t involve their families in end-of-life care decisions.
Q: What can be done to improve end-of-life care for inmates?
A: It is essential that we prioritize the humane treatment of all individuals, including those who are incarcerated, and work to ensure that they receive the care and dignity they deserve at the end of their lives. This may involve providing training and education to prison staff, improving communication with families, and ensuring that inmates have access to necessary medical care and pain management.
