Michele DiTomas, MD ’00Although the hospice unit emerged from the AIDS crisis in the ’90s, many of DiTomas’s patients today die from age-related illnesses. Prisoners age 55 and older are the fastest-growing population in federal and state prisons. Some of these inmates are now so frail that they lack the strength to harm others, even if they wanted to.

Take, for example, Mr. Johnson*, an inmate edging toward 90 who relies on a walker to get around. When Mr. Johnson first entered prison, he faced a sentence of 7 years to life. He told DiTomas that he'd accidentally killed a man during a fight that resulted from drug use.

“He always thought if he just followed the rules and served his time, he’d go home to his wife and kids,” DiTomas said. “So far, he’s been a model prisoner. For 37 years.”

Mr. Johnson’s wife died before he could see her again.

DiTomas has served as the chief physician and hospice medical director at the prison since 2007. She’s seen a lot of injustice during that time: young prisoners facing long sentences for relatively minor crimes and older inmates who have spent so long in prison that they scarcely resemble their younger selves.

“When you look at it from the outside, it sometimes seems like, ‘Oh, these are bad people. They should be put away,’” she said. “But I haven't met any patients who don't have complexity in their stories.”

DiTomas doesn’t just provide medical care to these prisoners. She’s spent years learning how to navigate the prison system from the inside, pushing for changes both large and small that can help her patients. Those accomplishments range from getting a prisoner a leg brace he needed – despite an institutional concern that he might use it as a weapon – to securing the approvals needed to send an elderly or dying prisoner home early.

The latter, known as compassionate release, requires a lot of paperwork and bureaucratic hurdles. To qualify, prisoners must have a prognosis of less than six months to live. But the process can take four to six months. While research shows that older prisoners typically pose a low risk of committing another crime, many applicants for compassionate release are rejected or simply die waiting. On the federal level, the Bureau of Prisons approved just 6 percent of compassionate release applicants between 2013 and 2017.

That’s why DiTomas educates other health care workers, teaching them to how to advocate for compassionate release as rapidly and effectively as possible.

“You just can't stop when somebody says no,” DiTomas said. “If you can't nudge, ask somebody else to nudge for you … Almost every positive outcome that has given me fulfillment in this job has come from pushing the boundaries.”

DiTomas’s commitment to helping patients with complex challenges stems from her medical education at UCSF and residency at what’s now Zuckerberg San Francisco General Hospital and Trauma Center.

“I was exposed to a lot of people who had mental health issues, who struggled with homelessness, struggled with intermittent incarceration and substance use,” DiTomas said. “Training in that setting gave me a lot of experience with understanding where people come from.

“I also think it made me a better doctor. Someone might come in seeking drugs, trying to get pain meds. But when you spend an extra 10 minutes hearing about what their childhood was like and how their father was a dentist who had narcotics in their garage – how he and his brother became addicts, and then they were homeless, and then they got arrested – that takes you to a really different treatment pathway.”

DiTomas’s first experiences at the Vacaville facility came about because a UCSF mentor recruited her to join an initiative to improve health care in prisons. Over time, she found herself increasingly dedicated to that mission. She wanted to play a part in changing how prison staff view their roles, shifting the focus from confinement to rehabilitation.

In addition to compassionate release, DiTomas listens to her patients’ concerns and tries to push for exceptions to prison policy that will help make their lives a little better. Along the way, she’s worked with a wide variety of staff. Take, for example, the correctional officer who helped DiTomas arrange for a dying prisoner to say goodbye to his daughter, who was held in another facility.

“He said he'd been working in corrections for 20-something years, and this was one of the most rewarding things he had done,” DiTomas said.

In the past few months, DiTomas’s team has faced one of its biggest challenges yet: the threat of COVID-19 spreading within the prison, where social distancing can be difficult. As they work to mitigate the risks to patients, DiTomas and her colleagues are constantly balancing the need for physical protection from the virus against the need for activities that protect prisoners’ mental health.

Despite the ethical dilemmas involved in her job, DiTomas remains committed to advancing the rights of her patients.

“[In the US,] we’ve sort of got the mindset of ‘We just put people behind bars, and we don't have to deal with them anymore,’” DiTomas said. “But the reality is, even in this country, people [in prison] are going to come back to your neighborhood. And it would be much better to have somebody who's been treated like a human being.”

Michele DiTomas won a 2020 UCSF Campaign Alumni Award in “The Compassionate” category. The award honors individuals whose work is marked by boundless empathy, understanding, and caring within health care or science.

*This is a pseudonym used to protect privacy.

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