Dean Mallis spends his final days surrounded by the concrete walls of an 8-foot by 10-foot cell at the Cumberland County Jail. His frail, blemished body languishes beneath a blanket on a bed platform bolted to the wall.
Occasionally he summons the energy to walk to the other side of the cell to use the toilet. Mallis rarely takes food and weighs just 62 pounds. The 26-year-old is dying of complications from AIDS.
'Having a disease in jail like this is like suicide,'' Mallis said Friday, half his mouth blackened with infection. 'I don't want to die in jail.''
Mallis has an advocate in Sheriff Mark Dion. Recently, Dion met with representatives from the state Attorney General's Office and the state departments of mental health and substance abuse to search for an alternative.
'I just feel it's inappropriate that someone should have to die or experience this level of disease while in a jail facility,' Dion said. 'We're not a hospice. We're not a hospital. We are criminal justice professionals asked to manage health care processes.''
The jail does have a health care provider. But that company has been criticized for failing to meet basic medical needs at the jail, and it is not staffed or equipped to care for someone in the final stages of AIDS or another fatal illness, Dion says.
The jail's medical staff believes a hospice facility is the best option for Mallis, though the county is seeking the opinion of a doctor with experience in dealing with AIDS. The difficulty is Mallis will be a challenging patient, one some health care providers may be reluctant to care for voluntarily.
Technically speaking, Mallis is in jail awaiting trial on charges of sexually assaulting a mentally challenged man who says he was held against his will in a Kennebunk motel room. He was jailed most recently for violating bail conditions by allegedly harassing other people with AIDS and AIDS workers who have tried to help him.
'When you look at his condition, his criminal behavior becomes moot,' Dion said. 'We have a human being. What do we want to do with him that's appropriately humane and meets our legal responsibility around custody? That's the balancing act.'
Although Mallis' situation is extreme, jails and prisons will increasingly deal with prisoners who are seriously ill, corrections officials say.
'He may be the first one who is so visible, but he won't be the last. We need to begin to consider what our policies will be,'' Dion said. 'I want to push the issue of what do we want to do about catastrophic illness when it becomes terminal.''
For now, veteran sheriff's Deputy Ben Smith has taken on the task of trying to accommodate Mallis' nonmedical needs as best he can, given his concerns about the nature of the virus that causes AIDS.
'It's nerve-wracking,' said Smith, who had to clean Mallis' cell four times in the previous two days. But Smith puts the best face on it and says he occasionally brings Mallis milk or ice cream, things he can swallow. 'I try to help. He's a human being.'