Story by Krissi Khokhobashvili, CDCR PIO II
Photos (above) by Don Chaddock, Inside CDCR editor
Photos (below) by Terry Thornton, Deputy Press Secretary
Office of Public and Employee Communications

Birds chirping. Butterflies flittering. Ivy inching up the sides of a trellis and the sound of water falling from a beautiful fountain. Three long, low peals of a bell marked the opening of a peaceful sanctuary in an unexpected location – inside the secure perimeter of a California state prison.

The garden at California Medical Facility (CMF) was created for the patients, volunteers, family members and staff of the nation’s first licensed prison hospice. The garden’s June 1 dedication was the result of more than 20 years of visionary work by dozens of CDCR medical and custody staff, administrators, volunteers, incarcerated people and activists to provide quality care to incarcerated patients in their final days.

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A bell is displayed in the peaceful hospice garden. Photo by Terry Thornton, Deputy Press Secretary.

“Right here in the middle of a state prison is a housing unit that defies all conventional wisdom for what a correctional environment should look like and how it should operate,” said Warden Robert Fox. “Right here in the middle of a state prison is a program that recognizes that at the end of one’s life, comfort, compassion and making peace with those who are left behind is something that all people deserve.”

It didn’t happen overnight. The garden’s roots go back to the 1980s and ’90s when the AIDS epidemic was ravaging communities, including American jails and prisons. Not long after the first AIDS-infected patients were identified within CDCR, the numbers of those infected rose dramatically, and AIDS became the most common cause of death among California prisoners.

“It was a very frightening time to be living with HIV,” said Dr. Joseph Bick, Chief Medical Executive at CMF. “The treatments were ineffective, and therefore a diagnosis of HIV carried with it an almost certain death sentence. HIV-infected people were shunned and ostracized everywhere, perhaps no more apparent than in our nation’s jails and prisons.”

In response, CDCR assembled a team of dedicated clinical and custodial staff to create the HIV treatment program at CMF, including dedicated clinicians such as Dr. German Maisonet and Dr. Jan Diamond, who served as the first chief medical officer of the new HIV treatment unit.  A number of people involved in the unit’s creation, now retired, came back to CMF for the June 1 garden dedication, including statewide medical director Nadim Khoury, administrators Mike Pickett and Bobby Houston, volunteers, activists and executives.

While CMF’s program was growing, the treatment inside prison still lagged behind medical advances available in the community. In 1992, hundreds of patients and incarcerated supporters, including Brian Carmichael, Peter Yvanovitch and Charles Perry, coordinated a medication strike and hunger fast to raise awareness. Joined by activists including Jim Lewis and Judy Greenspan, who was at the dedication, and the organization ACT UP San Francisco, the patients brought international media attention to the issue, catching the eye of a young man who would later oversee the hospice program.

“It was the media coverage of these events that first made me aware of correctional healthcare,” Bick said, “and led me to understand this is where I needed to be.”

Those courageous efforts resulted in increased awareness and funding for HIV and AIDS treatment in correctional settings, the establishment of an HIV advisory committee to improve conditions throughout the state, the appointment of Ombudsman Sterling Oran to interface between the department and patients’ loved ones and activists, and an increase in volunteers to come spend time with patients. In 1993, CMF became the first prison in the United States to have a fully licensed hospice.

It was during these years of growth, struggles and victories that volunteers including Nancy Jaiks and her husband, Bob Alexander, began giving their time to share space and empathy with CMF’s hospice patients. Jaiks and Alexander were students of Elisabeth Kübler-Ross, the acclaimed psychiatrist and author of “On Death and Dying.” Demonstrating her model of compassion and dignity in death, Jaiks and Alexander, along with numerous hospice volunteers, sought to improve the end of life for patients who were dying, in many instances, after long prison sentences and without the presence of loved ones. Shortly after, Jaiks introduced CMF clinical staff to Professor Clare Cooper-Marcus, an architecture professor at the University of California Berkeley, an expert in the area of therapeutic landscapes in hospitals and other healthcare facilities. According to Cooper-Marcus, “healing gardens” provide a place of refuge while promoting the health of patients, family and staff. The space itself encourages social interaction, reduces stress and promotes a feeling of well-being, which can lead to health benefits such as improved moods, reduced anxiety, and even lower blood pressure.

Over the years, the desire to install a garden space for the hospice grew, and numerous people shared their time, expertise and creativity to make it happen. A 2016 grant from the California Healthcare Foundation funded the design concept plans, created by PGAdesign in Oakland. Deborah Hysen, director of Facilities Construction and Project Management for CDCR, oversaw the team who designed and installed the garden and even encouraged the team to think beyond the original plans for the garden, extending it out as far as the space allowed.

CDCR’s Inmate Ward Labor program performed the construction and installation work, uniting a team of construction professionals and incarcerated vocational workers to build every structure and sow hearty, drought-tolerant California native plants.

“I’m so glad to come here today and see this beautiful environment,” said CDCR Secretary Scott Kernan. “When I see everybody here today I think of the policies the department has tried to make that create hope in the system. Thank you for supporting this wonderful space that really is a symbol of what the department is all about.”

Kernan began his career as a correctional officer at the height of the AIDS epidemic, and spent a considerable portion of time at CMF as a lieutenant and captain. Several people who spoke at the dedication expressed their appreciation for Kernan’s unending support for health care improvements, and his support for the garden from the beginning. The secretary pointed out that not only is the garden a peaceful space for patients, it is also an illustration of the direction the department is going in creating settings that encourage rehabilitation.

Jaiks, who spoke at the dedication, applauded the garden team for their efforts and emphasized the role of retired Catholic Chaplain Patrick Leslie, who started the Pastoral Care Services (PCS) program to minister to dying patients.

“It was your dream,” she reminded Leslie, who was in the audience, “that no man should die alone. Because that’s what was happening, quite often.”

Jaiks took a special moment to thank the PCS team, a group of incarcerated people who assist hospice patients with daily activities like bathing and shaving, provide companionship and empathy and, most importantly, a friend to be there in their final moments.

“I regard this place as a sacred place,” Jaiks said. “I like to use the term ‘healing into death.’ That is what hospice is all about. These gentlemen are who I call the ‘ambassadors of peace’ here at prison.”

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The garden space features drought-tolerant plants, a gazebo and shaded area for patients, staff and volunteers to rest.

Jaiks presented the men with a small but significant token – a stick from the center of a Native American medicine wheel in Sedona, Arizona. The medicine wheel symbolizes dimensions of health and cycles of life, and has been used in healing ceremonies for generations. Jaiks gave the stick to the workers to bury in their garden.

“I think it’s beautiful,” said Cartis Wilcox, a PCS worker, as he looked over the new garden. “It’s openness, where people don’t feel confined. You can interact with nature and feel a part of nature, I think it’s a beautiful thing – I think it was necessary.”

As the ceremony wound down and CDCR executives prepared to cut the ribbon on the garden, Hysen took the podium to share one last surprise. Acknowledging the years of hard work by a team of staff, volunteers, incarcerated men and community partners, she pointed out that at the helm of the operation was one person quick to heap praise on those around him and stay out of the spotlight.

“As is often the case, one person with the dedication to their craft and clarity of purpose can shine a light in a direction that nobody before had thought to travel, and in doing so, light the way for others to follow.”

That person, she said, is Dr. Joseph Bick. She led Bick to a rock in the center of the garden, moving aside a floral arrangement to show the plaque dedicating the garden to Bick.

Rev. Keith Knauf, who has served as Protestant chaplain at CMF since 1995, offered a blessing over the garden that, to the dozens gathered to share its dedication, summed up the purpose of the healing space.

“May souls be fed here, strangers become friends here, community be grown here, patients and families be healed here.”