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Death and redemption in an American prison

The cemetery at the Louisiana State Penitentiary, also known as Angola, is for prisoners who don't have families that can give them a burial. Hospice began at Angola in 1997, when 85% of inmates were serving life sentences.
Annie Flanagan
Washington Post via Getty Images
The cemetery at the Louisiana State Penitentiary, also known as Angola, is for prisoners who don't have families that can give them a burial. Hospice began at Angola in 1997, when 85% of inmates were serving life sentences.

Steven Garner doesn't like to talk about the day that changed his life. A New Orleans barroom altercation in 1990 escalated to the point where Garner, then 18, and his younger brother Glenn shot and killed another man. The Garners claimed self-defense, but a jury found them guilty of second-degree murder. They were sentenced to life in prison without parole.

When Garner entered the gates at Louisiana State Penitentiary in Angola, Louisiana, he didn't know what to expect. The maximum security facility has been dubbed "America's Bloodiest Prison" and its brutal conditions have made headlines for decades.

"Sometimes when you're in a dark place, you find out who you really are and what you wish you could be," Garner said. "Even in darkness, I could be a light."

It wasn't until five years later that Garner would get his chance to show everyone he wasn't the hardened criminal they thought he was. When the prison warden, Burl Cain, decided to start the nation's first prison hospice program, Garner volunteered.

In helping dying inmates, Garner believed he could claw back some meaning to the life he had nearly squandered in the heat of the moment. For the next 25 years, he cared for his fellow inmates, prisoners in need of help and compassion at the end of their lives.

The Angola program started by Cain, with the help of Garner and others, has since become a model. Today at least 75 of the more than 1,200 state and federal penal institutions nationwide have implemented formal hospice programs. Yet as America's prison population ages, more inmates are dying behind bars of natural causes and few prisons have been able to replicate Angola's approach.

Garner hopes to change that. But first he had to redeem himself.

'Life means life'

Garner, the son of a longshoreman, was born and raised in New Orleans as one of seven kids who kept their mother busy at home. He attended Catholic primary school and played football at Booker T. Washington High School. After graduating, Garner worked for a garbage collection company, then for an ice cream manufacturer, testing deliveries of milk to make sure they hadn't been watered down.

None of that experience would help him at Angola, where violence seemed to be everywhere. Garner remembered the endless stream of ambulances rolling through the prison gates.

"All day long: Somebody has gotten stabbed, somebody had gotten into a bad fight, blood everywhere," he said.

Cain arrived at Angola in 1995, three years into Garner's life sentence. In 1997, the warden came across a newspaper article about a hospice program in Baton Rouge, the state capital.

"I realized that if we did hospice, I wouldn't have to do that rush at the end of life. We wouldn't have to put them in an ambulance and send them to the hospital," Cain said. "We could let them die in peace and not have to do all that."

Donald Murray is one of the few selected inmates who take care of other aging inmates at Angola prison in Louisiana. Here he cares for Clyde Giddens.
Annie Flanagan / Washington Post via Getty Images
Washington Post via Getty Images
Donald Murray is one of the few selected inmates who take care of other aging inmates at Angola prison in Louisiana. Here he cares for Clyde Giddens.

At first, the prison's medical staff objected, worried about the cost. But Cain put his foot down. He hired a hospice nurse to run the program, and inmates would provide the day-to-day care at no cost.

Cain sought volunteers and funding from what he called the prison's "clubs and organizations" — the Aryan Brotherhood, the Black Panthers, as well as the religious congregations within the prison walls. "All of y'all one day are going to be in hospice," he said he told them.

It was no exaggeration. In Louisiana, as the saying goes, life means life, with no chance of parole. And at that time, 85% of those sent to Angola would die there, according to Cain and others.

"We buried more people a year than we released out the front gate," Cain said.

Many serving life sentences no longer had family outside the prison walls, and for those who did, their families often could not afford to pay for a funeral or burial spot. So, the prison would bury the bodies at Angola. When the first cemetery was filled, the prison established another.

Initially, inmates were buried in cardboard boxes. But during one funeral, the body fell out of the box onto the ground. Cain vowed that would never happen again and instructed inmates working in carpentry to learn to make wooden caskets. The prison then provided caskets for any inmate in Louisiana whose body was not claimed by their family. The late Rev. Billy Graham and his wife were buried in two plain wooden caskets made at Angola.

The casket of Reverend Billy Graham, who died in 2018, was made by incarcerated men in Angola prison.
ALEX EDELMAN / AFP via Getty Images
AFP via Getty Images
The casket of Reverend Billy Graham, who died in 2018, was made by incarcerated men in Angola prison.

Cain saw the hospice program as part of his approach of rehabilitation through morality and Christian principles. Cain started a seminary program at Angola, had the prisoners build several churches on its grounds, and considered hospice "the icing on the cake."

The early days

Garner had never heard of hospice.

He was among the first 40 volunteers at the prison, hand-picked for their clean disciplinary records and trained by two social workers from a New Orleans hospital in 1998.

Isolation cells were remade to serve as hospice rooms. The volunteers repainted the walls and draped curtains to hide the wire mesh covering the windows. They brought in nightstands and tables, TVs, and air conditioning.

Soon, it became clear the prison would have to change its rules to accommodate hospice. Before the program existed, inmates weren't allowed to touch each other. They couldn't even assist someone out of a wheelchair.

"They would actually push them into a room and wait on the nurse or doctor or somebody else to assist them," Garner said. "They would die alone. They had nobody to talk to them, other than nurses and doctors making their rounds. They really didn't have nobody that they could relate to."

The volunteers were issued hospice T-shirts that allowed them free movement through the prison. Cain made it clear to the correctional officers and the staff that if someone was wearing that shirt, it was like hearing directly from the warden.

"He had to rewrite policies so everything that a hospice program can do in society, that program can do as well inside corrections," Garner said.

The primary rule of the hospice program was that no one would die alone. When death was imminent, the hospice volunteers conducted a vigil round-the-clock.

The program used medications, including opioids, for the palliative care of patients, though the inmate volunteers were not allowed to administer them.

The first hospice patient Garner saw die was a man the prisoners called Baby. Standing just 4-foot-5, he was sought out by other inmates for his self-taught legal expertise. In 1998, as Baby was dying from cirrhosis, a disease of the liver, inmates rushed in to get his advice one last time.

"So many people wanted to see him, we just didn't have enough room to take everybody in," Garner said. "We used to have to do increments of 10 guys or whatever."

Baby had taken care of everybody else. Now it was their time to take care of him.

Most of the hospice volunteers were serving life sentences, and many, like Garner, had taken someone's life to get there. But holding a man's hand as he took his last breath provided a new perspective.

"We all don't know much about death, only what we see through the eyes of somebody who was going through that transition," Garner said. "It was new to me, because I didn't understand it in its entirety until I got into the program."

The hospice volunteers became the conduit for inmates to get messages to their dying friends.

But more importantly, they functioned as confidants, giving dying inmates a last chance to get something off their chest.

"You become their hands, you become their eyes, you become their feet, you become their thinking sometimes," Garner said. "They're so vulnerable to where you actually have to be so mindful and careful to carry out their will."

In a place where people prey on weakness, hospice volunteers shared in each patient's vulnerability. Instead of assaulting, they assisted. Instead of sowing conflict, they spread peace.

"Just a touch makes a big difference, when a person can't see or a person can't hear," Garner said.

'What about quilting?'

As the years passed, hospice deaths became more prevalent, with two to three inmates dying a week. The prison population was graying, and not just at Angola. According to federal statistics, from 1991 to 2021, the percentage of state and federal inmates 55 and older grew from 3% to 15%. And in 2020, 30% of those serving life sentences were at least 55 years old.

Throughout the 2000s, the Angola hospice saw increasing deaths from cancer, hepatitis C, and AIDS. But mostly, the patients' bodies were wearing out. Most had come from low-income backgrounds and arrived at Angola in less-than-optimal health. Prison took a further toll, accelerating aging and exacerbating chronic conditions.

The hospice volunteers tried to grant the dying inmates' often modest last requests: fresh fruit, a peanut butter and jelly sandwich, some potato chips.

"A bag of chips, to people in society, it's like, 'Oh man, that ain't it,'" Garner said. "But to somebody that has a taste for it or for somebody that's about to pass away, their wanting is everything."

But those wishes cost money. In 2000, the prison volunteers were brainstorming ways to make the program self-sufficient.

"What about quilting?" suggested Tanya Tillman, the hospice nurse.

The room fell silent, Garner recalled. The volunteers looked around nervously.

"That was not something that a male inmate wanted to hear," Garner said.

But the other "clubs and organizations," as Cain called the inmate groups, were also raising money through fundraisers. They needed something that would stand out, something they would have no competition over.

"And so we voted," Garner said. "Quilting it was."

None of the men had quilted before. Some women came to teach them the basics, but mostly they learned through trial and error.

"I just put a sewing machine in front of me," Garner said. "I knew all the do's and don'ts, but I didn't know how to take and cut fabric, and put fabric together, and make it make sense."

They auctioned off their first quilt at the Angola Prison Rodeo, a biannual event in which prisoners compete in traditional rodeo events. It attracts people from all over the world.

At one point, Garner and his team were making 125 or more quilts a year: throws, kings, and queens.

"Within five years, we was on the front cover of Minnesota Alumni magazine," Garner said, referencing the University of Minnesota Alumni Association's publication. "In 2007, we were on another front cover, Imagine Louisiana magazine, and then in 10 years, we was in documentaries with Oprah Winfrey," Garner said.

A banner advertising the Angola Prison Rodeo pictures warden Burl Cain, who started the penitentiary's hospice program.
Mario Tama / Getty Images
Getty Images
A banner advertising the Angola Prison Rodeo pictures warden Burl Cain, who started the penitentiary's hospice program.

The Oprah Winfrey Network profiled the prison hospice program in 2011 in a documentary titled "Serving Life."

Quilts made in Angola now hang in The Historic New Orleans Collection, the Smithsonian Institution's National Museum of African American History and Culture in Washington, D.C., and the National Hospice and Palliative Care Organization building in Alexandria, Virginia.

One of the first quilts Garner made was a passage quilt, used instead of a plain white sheet to cover bodies being transported to the morgue. The quilt showed the clouds opening and angels receiving the inmate into heaven. It was adorned with the words, "I'm free, no more chains holding me." Garner made another quilt to drape over the casket during funeral processions.

The program used the proceeds from the sale of other quilts to stock a cabinet with food and other sundries the hospice patients might need. If a patient's family did not have the money to travel to Louisiana to see their loved one in his final days, the program would pay for their airline tickets. The family could stay overnight in the patient's room, something that was unheard of in a maximum security prison.

The hospice program broke a lot of prison norms, and seemingly anything was on the table. When one hospice patient's dying wish was to go fishing, the volunteers got the warden's approval and brought a group of inmates with him.

The Mississippi River surrounds the Angola area on three sides, and the staff baited a fishing hole for days before the excursion so fish would be biting when the dying man arrived.

The fishing excursion became an annual event.

"You see the smile on their faces catching those fish," Cain said. "They forgot all about that they were terminal."

He added, "It teaches us to normalize our prisons and quit making them abnormal, bad places, and make it make people think they're bad people. Hospice is the best example of all, to teach you to give back and then you will heal, and you won't have more victims when you get out of prison."

A change in prison culture

Soon the impact of hospice was being felt well beyond the volunteers and their patients.

"It's changed the culture of their facilities. It changed the general population," said Jamey Boudreaux, the executive director of the Louisiana-Mississippi Hospice and Palliative Care Organization. "The general population sees people caring and it's kind of contagious."

When Boudreaux was hired in 1998, his first task from the board of directors was to shut down the hospice at Angola.

"They're calling something hospice," he recalled the board telling him, "and we can just see that there's going to be some sort of big scandal and hospice is going to get a bad name."

He called the prison and Cain invited him to come see the hospice program in person. Boudreaux, who had never been in a prison before, sat through a two-hour meeting with hospice volunteers and correctional officers.

He didn't shut it down. Instead, he continued to attend monthly meetings at the prison for the next five years. Eventually, the administrators asked him if he'd feel comfortable being there alone with the volunteers, so they could speak more freely.

"I got to know these guys and they were genuinely committed to this whole notion of taking care of people at the end of life," he said. "For some of them, it was a way to find redemption. For others, it was an affirmation that, 'I don't deserve to be in this place. And this gives me a very safe place to spend my time in prison.'"

The concept of prison hospice began to spread. In 2006, and again in 2012, Angola hosted a prison hospice conference. Now, five of the eight state prison facilities in Louisiana have inmate volunteer hospice programs. Nationwide, about 75 to 80 hospice programs operate behind bars.

"Most are pretty basic," said Cordt Kassner, a consultant with Hospice Analytics in Colorado Springs, Colorado. "Angola is head and shoulders the model; the best one, period."

Regaining freedom

Between caring for patients, sewing quilts, and working in the prison library, Garner had little time for anything else, though he continued to push for his case to be reviewed to earn his freedom.

Then, during the covid-19 pandemic, the quilters were asked to sew masks for the prison. The prison set up shifts so prisoners could maximize use of the sewing machines, keeping them running 24 hours a day. Masks were shipped to other prisons as well. Garner estimated he made 25,000 masks.

"I actually had to take time away from my work, from trying to get out of that place, working legal work and stuff," Garner said.

Finally, in 2021, his case was reviewed by the Orleans Parish District Attorney's Civil Rights Division. A judge agreed with the district attorney that in receiving life sentences at Angola, Garner and his brother had been oversentenced. They offered the brothers a deal: They could plead guilty to the lesser charge of manslaughter and be released for time served.

Garner had to think about it. His lawyers told him he likely had a good case to sue and be compensated for the many years he had spent in prison. But if he took the deal, he couldn't sue.

"I could fight it or gain my freedom," he said.

His family wanted the brothers home. Garner had lost his mother, his father, two brothers, and an aunt while behind bars. He and his brother opted to forgo any money that might come their way and secured their release.

"Steven Garner came in as a horrible criminal," Cain said. "But he left us a wonderful man."

Most of Garner's immediate family had moved to the Colorado Springs area after being displaced by Hurricane Katrina, and in January 2022, after serving 31 years in prison, he joined them.

Spreading the message

Quilting is an art of putting scraps of fabric together, making everything fit coherently. Now out of prison, Garner had to find a way to make all the pieces of his life fit together as well. He found a job at a warehouse, rented a home near his family, and bought himself a car.

At his prison job, he made 20 cents an hour — $8 a week, $32 a month — that he used to buy soap and deodorant. It's a strange feeling today, he said, to be able to go into a store and buy something that costs more than $32.

Now 51, he has missed the prime years of his adult life. But rather than trying to make up for lost time in some grand hedonistic rush, Garner went back to what had saved him. He started a consulting business to help prisons implement hospice programs.

An inmate holds onto a fence during the Angola Prison Rodeo. The maximum security prison in Louisiana holds 5,000 men, the majority of them serving life sentences.
Mario Tama / Getty Images
Getty Images
An inmate holds onto a fence during the Angola Prison Rodeo. The maximum security prison in Louisiana holds 5,000 men, the majority of them serving life sentences.

Over the past two years, he has delivered speeches at state hospice association conferences, and last year he spoke at a meeting of the Colorado Bar Association.

For many hospice veterans, prison hospice reminds them of the initial days of hospice, when it was primarily a nonprofit entity, run by people called to serve others.

"You would be hard-pressed to find a hospice provider that's willing to support hospice in correctional facilities," said Kim Huffington, chief nursing officer at Sangre de Cristo Community Care, a hospice based in Pueblo, Colorado. "Hospice as an industry has undergone a lot of change in the last 10 years and there's a lot more for-profit hospices than there used to be."

Yet talking to Garner, she said, has reignited her passion for the field.

"In many situations, we tend to dehumanize what we don't understand or have experience with," Huffington said. "The way he can make you see what he's experienced through his eyes is something that I take away from every conversation with him."

In September, Garner went back to prison, this time at the behest of the Colorado Department of Corrections, which wanted his advice on how to restart a defunct hospice program at Colorado Territorial Correctional Facility in Cañon City.

It was a surreal experience entering a prison again, dropping his keys in a little basket at the security screening, knowing he'd get them back shortly.

"It was really just another experience in my life," Garner reflected, "that I can come and go, rather than come and stay."

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

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Markian Hawryluk