Dispatches the Ultimate Health-Care Story

By MARC HEQUET, in Rochester, Minnesota

DeWayne Murphy, also known as Prisoner 06764-045, won't step outside during winter: the frigid Minnesota air leaves him gasping. His sleep is plagued by night sweats and cramps. "They sent me here to be rehabilitated," he says of the Rochester Federal Medical Facility, where he is incarcerated. "But how can you be rehabilitated if you die?"

He's got a point. Though Murphy is just a first-time felon serving a mandatory four-year sentence for drug possession, the ailing 33-year-old inmate finds himself on a kind of de facto death row; his weakened heart has one-sixth its normal pumping power. He needs a transplant.

New hearts are difficult for anyone to come by; for inmates, it's even harder. The U.S. Bureau of Prisons doesn't pay for transplants. Medicare will pay -- if Murphy is released. The bureau will release Murphy -- if a doctor accepts him for the necessary pre-transplant work-up. But no doctor will take him -- unless he's released.

It may sound like a somewhat heavy-handed lampoon of the American health- care system -- bad Joseph Heller, say. It gets worse. If Murphy is furloughed for the prolonged pre-transplant regimen, afterward he would return to prison. Would he be furloughed promptly again if a heart became available unexpectedly, as donor hearts are wont to do? The Bureau of Prisons says he would be. Murphy has his doubts. Doctors see a logistical snarl that could hopelessly compromise the success of the transplant. The authorities shrug. "The Bureau of Prisons doesn't have a hang-up," explains Robert McFadden, executive assistant to the warden at Rochester. "When we're presented with the information we request, we can go forward."

Murphy's troubles started in 1990, when he was fired from his job as a warehouse foreman in Kansas City, Missouri, for being sick too much. Suffering from what he thought was pneumonia, he got a chest X ray, which showed that his heart was greatly enlarged. He was told he would need a transplant and placed in intensive care.

Murphy improved just enough to be released. Divorced, broke and sick, he was arrested with a bag of methamphetamine in his home in 1991. He says he was merely keeping it for a friend, though in anticipation of being paid for doing so.

Pudgy, stringy-haired, constantly out of breath, Murphy has deteriorated & since he was incarcerated in March 1993. A local attorney has filed suit against the Bureau of Prisons seeking his release, but Murphy doesn't really have time for a protracted legal battle. When he arrived at Rochester, he says, he could walk a lap or two on the prison track. Now he's winded after climbing down a flight of stairs. He must sleep virtually sitting up, and gets oxygen all night. He fears that a heart attack or stroke could leave him on life support rather than kill him outright. "Serving a four-year sentence on life support," Murphy shudders. "That's scary." Ironically, his life seeps away just minutes from the Mayo Clinic, home to a world-famous heart- transplant program. "It drives me crazy," he says. He stops to breathe. "I'm sitting here dying, and there's nothin' I can do about it."