This week's blog is the second in a three-part series about Hosparus Health’s volunteer program at the Kentucky State Reformatory, sharing stories of both the inmates who offer companionship and vigil to dying inmates, and the volunteers and staff who support the program. Click here to read Part 1.

Dr. George Webb first became involved with Hosparus Health’s prison hospice program in 2004. At the time, he was on staff as Associate Medical Director. Paula Cook (Harshaw), Hosparus Health volunteer services, asked Dr. Webb if he would like to join her and a couple of other volunteers on their scheduled visits to the prison. Dr. Liz McKune, the prison psychologist at the time, then enlisted Dr. Webb to meet with the prison physicians to educate them about hospice and symptom management.

While the prison hospice program follows the hospice model of care, there are some differences because of the setting. One of those is the strict limits on what type of medications are used and how they are administered. Throughout his career, Dr. Webb continued to speak with physicians at KSR and at prisons across the state about symptom management and end of life issues.

In April 2005, Dr. Webb wrote a column for the Greater Louisville Medical Society called “Released to Death: End of Life Care Behind Walls.” The name of the article came from the way inmates were listed in reports. If an inmate had died in prison, they would be marked “Released to Death.” While the statistics Dr. Webb lists in his article have changed, the trend of an aging population in prison reflects the trend of aging in the United States. In 2013, about ten percent of the nation’s prison inmates were 55 or older. By 2030, it is estimated that one third of all inmates will be over 55.

Additionally, prisoners age faster than the general population because they tend to arrive at prison with more health problems or develop them during incarceration. Dr. Webb closed his column with the following: “One of the basic beliefs of hospice is that everyone who has a terminal illness should have the opportunity to die pain free, surrounded by caring people in the location of their choice. Even though we may not be able to change the location of their death, we should be able to offer a death with dignity and compassion for prison inmates. In spite of the fact that these individuals may have participated in some very serious crimes, we should be able to provide compassionate end of life care.”

In his role as a medical advisor, Dr. Webb helped the prison volunteers offer more compassionate care. When the program was first started, the inmates could not touch each other. Even the hospice volunteer inmates could not provide the small gesture of a comforting touch with a dying inmate.

The first time that Dr. Webb led a training with the infirmary staff about terminal restlessness and suggested touching the patient’s back to help calm them down, he was told that would not be acceptable in prison. Dr. Webb talked with Dr. McKune about the importance of this, and over time permission was granted by the warden. Being able to touch another inmate remains exclusive to the hospice program.

In addition to continuing to deliver his training talks, Dr. Webb is a valuable resource to the prison group. In two recent meetings, he discussed some of the prevalent diseases in the prison and answered the numerous medical questions from the inmates.

Over the 15 years of his involvement in the program, Dr. Webb has witnessed a lot of turnover in the group of volunteers. He says the current group has become very close, like a family. All the volunteer inmates know all the patients in the hospice program, and in many instances have known some of these inmates for the 20 to 30 years that they’ve been in prison together. The inmates also know patients on the separate dementia ward or throughout the prison population and frequently say, “Keep an eye out on so and so. I’ve noticed they haven’t been themselves lately.”

In addition to answering medical questions, Dr. Webb helps the volunteers deal with their grief and loss of their friends. In one recent meeting, Dr. Webb explained to the prisoners the concept of his “grief tank.” He said that as a physician, he saw a lot of death and experienced grief frequently. Now those losses are more personal to him, but all his grief goes into the grief tank, the place near his heart that holds this emotion. He explained how his tank could only hold so much, and then he would need to take care of it, take care of himself, and feel those losses for his grief tank to empty and be able to hold more again. The inmates knew this concept well enough, but didn’t have a way to describe it. Talking about grief normalizes the emotion for the group and creates a safe place for the volunteers to sit with their own.

Besides being a resource for the volunteer inmates, Dr. Webb has been an advocate for them and has helped to improve and change the prison hospice program. His work has helped many inmates who are released to death have a more compassionate one. We are so grateful to Dr. Webb for all he does for our prison program!

Check back next week for the final installment of our series, a story about some of our volunteer inmates.