One of the dreariest sections of Halawa Correctional Facility is the second-floor medical unit where acutely ill and dying inmates are confined in hospital beds or walled off in a separate section for the psychotic.

The only decoration in the medical unit is a line of paper leis dangling from a string on the wall behind the front desk — leis made in a crafts class by mentally ill prisoners to celebrate May Day. They are the kind of childish paper-and-drinking straw creations normally on display in elementary school classrooms.

The sick inmates here are doubly incarcerated as they languish behind bars to serve out long sentences for their crimes, and also lay bed-ridden, trapped by their failing bodies. Some will die in prison.

Halawa’s medical unit houses the most severely ill inmates in the state prison system.

Inmate Kristopher Shafer assists with feeding with Right, inmate Dustin Jenette at the Halawa Prison infirmary. 26 may 2015. photograph Cory Lum/Civil Beat

Inmate Kristopher Shafer helps with the feeding of a fellow prisoner at the Halawa Correctional Facility infirmary.

Cory Lum/Civil Beat

Kristopher Shafer is one of a small group of Halawa inmates who have been carefully selected to be medical aides to comfort and care for the frail and dying criminals.

“You can’t be in a prison gang, you can’t be impatient or violent and you can’t be a sex offender,” Shafer says. “The sick inmates are very vulnerable. Some of them are paralyzed. They can’t defend themselves.”

Public Safety director Nolan Espinda says that very few inmates qualify to work as a heath aide in prison.

“In order to be considered for the medical work line, inmates must go through an extensive interview process. It requires a lot of dedication,” Espinda said.

In a small way, Shafer and the other aides are helping to reduce the state’s escalating cost of caring for sick inmates — $23 million this year. That cost to the taxpayers goes up every year.

Shafer and the other inmate aides do jobs the prison would otherwise have to pay orderlies from outside to handle. Their work frees up the prison nurses to devote more of their time to deliver medical care to the sick.

“It is imperative we have these guys,” says Halawa warden Francis Sequeira, “They are incredibly helpful. It takes a special kind of inmate to do this kind of work.”

Prison medical aides make 25-cents an hour. Shafer says they work 15 hours a day, seven days a week, making about $100 a month.

“We clean up blood, urine, feces and change colostomy bags, sweep, mop, dispose of bio-hazards, “ says Shafer.

Halawa prison guard peers out from the infirmary.  26 may 2015. photograph Cory Lum/Civil Beat

A Halawa prison guard peers out from inside the infirmary.

Cory Lum/Civil Beat

Shafer says the aides have to be trustworthy because they work around female medical personnel, and there are many temptations such as grabbing drugs or stealing small things to sell to other inmates such as soap, pens and little plastic bowls.

Shafer says inmates will buy the most trivial items because “they are forbidden; they like what they can’t get.”

He says he tells fellow inmates who show interest in working in the medical unit, “You have to be prepared to see things that don’t look so good.”

Besides cleaning up, the aides feed paralyzed and medically frail inmates, clothe and shower them, and encourage them to play games of   dominos and chess.

“You have to be very patient; you can’t be mean-spirited, especially with the mentally ill and demented patients,” Shafer says.

They soothe the sick and dying inmates in ways the regular medical staff cannot.

“We come here as human beings, as other inmates who are interested in them. We try to make them feel less isolated from the rest of the prisoners, “ says Shafer.

Shafer says some of their patients are hovering near death. Once when Shafer briefly left a patient’s room, he returned to find the inmate dead in his bed.

“You have to be prepared to see things that don’t look so good.” — inmate aide Kristopher Shafer

Another elderly man died while Shafter was lifting a spoon to the old man’s lips to feed him.

“He just stopped breathing. It was sad, but I was glad at the same time. He was in pain with stage four cancer. He weighed only about 80 pounds. He told me it felt like needles were stabbing his whole body. He knew he was going to die.”

Some patients Shafer has assisted eventually get out of prison. He says he felt very sad when a patient he especially liked was granted a medical release after the man’s daughter said she wanted to bring him home to die. The patient was 76.

“He was one of our favorites. I would put him in his wheel chair and feed him. He acted just like a kid. He would tell us jokes and sing Filipino love songs to us. He was frail and moved in and out of consciousness.”

How did the old man end up in prison?

“He killed his wife, stabbing her more than 70 times,” said Shafer.

No Going Home

The Public Safety Department says many families are unwilling to take their seriously ill or dying relatives home. They are either estranged from inmates or they don’t want to be responsible for their big medical bills.

Shafer, a Farrington High School graduate from Kalihi, entered prison 10 years ago on a burglary conviction for trying to steal a portable battery charger and other items from a garage. The homeowner, sleeping in the house, woke up and caught him.

Now 38, Shafer says before he was convicted he had been stealing for years to feed his crystal meth habit. He says he never hurt anyone, but admits he could have.

Last year, with only two years left on his sentence, Shafer was convicted of second-degree escape after he failed to return to the Laumaka Work Furlough Center. He was on the lam for a month before he was caught in Makiki.

Before he got into trouble, he had a job he enjoyed at The Queen’s Medical Center in transport services, moving patients around in wheelchairs and hospital gurneys.

He says he likes working as a medical aide. “I don’t like being cooped up in the prison module. Here I can get out to work all day. I can socialize with normal people.”

While serving long sentences, inmates develop the illness of the elderly such as dementia, Parkinson’s, heart disease and cancer.

“I get a good feeling helping the patients. They are old and very sick. I try to treat then like I would want my parents treated, “ says Shafer.

Among the elderly patients Shafer is helping care for is Patrick Constantino Russo who is virtually paralyzed from the neck down with multiple sclerosis he contracted in prison while serving 34 years of a life sentence.   Russo was imprisoned after he shot two men to death in the Sports Page Lounge on Kalakaua Avenue in 1980.

The 67-year-old Russo now can only move his arms a few inches.

Russo is qualified for parole, but the Public Safety Department says the parole board won’t release him until a facility can be found that’s willing to provide his 24-hour-a-day care. So far, no care home wants to accept the double-murderer.

“He is so profoundly disabled, it would be impossible for him to harm anyone, “ says retired attorney Bob Merce, who is working pro-bono to help Russo and other elderly, severely disabled inmates get medical releases.

The Public Safety Department also would like to see medical releases for more sick, elderly convicts now deemed harmless. When the inmates are released into care homes they qualify for federal Medicaid, saving the state hundreds of thousands of dollars.

History of Medical Woes

Public Safety spokeswoman Toni Schwartz says many inmates come into prison already in poor health from earlier lifestyle choices such as addiction to drugs and alcohol, or they are mentally ill or they have picked up life-threatening infections from living on the streets.

Halawa Clinical Services Administrator Tina Agaran says some inmates also have orthopedic and arthritis problems.

The Federal Bureau of Prisons cites several studies that report the average prisoner is 13 to 15 years older medically than the prisoner’s actual age, because of their poor health care before they were imprisoned and the stresses of life after they are locked up.

While serving long sentences, inmates develop the illness of the elderly such as dementia, Parkinson’s, heart disease and cancer.

Halawa warden Sequeira says because of overcrowding, only the most severely ill or immobile elderly inmates can be admitted to Halawa’s 24-bed medical unit, which he says it always full.

He says it becomes like a chess game for the staff to try to select which inmates are most in need of infirmary care and which other sick inmates are still well enough to be able to remain out in the general prison population.

I wish I could end this story on a positive note, but the punishment for crime often continues even after an inmate has paid his dues.

 

“We really need a larger medical unit,” he says. “We need at least 40 or 50 beds.”

A separate group of inmate medical aides cares for sick offenders considered fit enough to stay out in the modules with the other prisoners.

Deputy Public Defender Phyllis Hironaka says Ulysses Nahinu, a middle-aged inmate with a kind demeanor, has been caring for one of her clients in the general prison population for more than five years.

Her 75-year-old client murdered his girlfriend. He is physically robust but has dementia.

Hironaka says, “Ulysses very gently directs my client all day long to go where he needs to be going such as when he should line up to walk to chow because the old man is often forgetful and confused. Ulysses is a big guy who could protect my client from the other inmates if he had to. He is a kind and honorable man.”

Ulysses, who was imprisoned for crystal meth trafficking, is up for parole consideration this month.

And After Prison?

Public Safety director Espinda says he has seen prisoners’ lives change when they care for their sick and dying peers.

“It is their chance to give back in a positive way while they learn compassion and humility and patience as they improve the quality of care for the inmates.”

I ask Shafer if he considers his medical unit work a way to make amends for his previous life of drugs and stealing; if he sees his kindness to frail, sick inmates, redemption.

He says it has made him more patient. He says when he gets out of Halawa, he expects be a better father to his three children.

“After this experience, I will be more humble and kinder. The work is a way of paying back.”

I wish I could end this story on a positive note, but the punishment for crime often continues even after an inmate has paid his dues.

It would be uplifting to say that upon his release, the gentle Shafer will hone his medical skills by going back to school to study to become a physician’s aide or a nurse or even a doctor. But that is not to be.

Shafer says, “When you are a felon, it is hard to get a job in a hospital.”

Instead, he says he will aim for a union construction job with good pay to care for this wife and children, and continue to be the focused, hard worker he has become in prison.

'Main Street' of Halawa Prison.  26 may 2015. photograph Cory Lum/Civil Beat

A view of Halawa prison’s ‘Main Street.’ The medical ward has room for 24 inmates but prison officials say they need another 40 to 50 beds.

Cory Lum/Civil Beat

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