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Investigation Finds “Deadly Delays” in Cancer Diagnosis at Washington State Prisons

The OCO, a prison watchdog agency that reports to the governor, had previously conducted two investigations into delayed cancer management at the Monroe Correctional Complex. It continued to receive complaints regarding delays in cancer diagnosis occurring, so it undertook another investigation. The latest report detailed the care, or lack thereof, rendered to 11 prisoners at different prisons across the state.

The report did not name any of the prisoners, but the family of prisoner Michael Boswell said he was “Patient A.” Boswell, 37, sought treatment in May 2019 for a painful skin lesion on his back that was cracking and healing. The medical provider diagnosed it as a benign skin lesion that could not be removed. In the months that followed, Boswell sent medical kites and filed a grievance.

“He told them we have a family history of cancer. They ignored it,” said Boswell’s sister, Meagan Kineman. “They literally turned a blind eye.”

Boswell finally underwent an excision of the lesion in September 2019. It was identified as malignant melanoma.
He was not sent for a surgical evaluation until November 2019. “At that visit, the surgeon recommended ‘urgent’ full body imaging, lymphatic mapping, and re-excision of the melanoma site along with lymph node biopsy to check for metastasis,” the OCO report stated. “However, the imaging studies were not scheduled.”

Inquiries via medical kites were made by Boswell about when the mapping would occur. He finally received the “urgent” full body mapping in January 2020, but the lymphatic mapping did not occur until March 2020 after additional prompting via medical kites. The re-excision and lymph node biopsy did not occur until April 2020. By then, the cancer had spread to a lymph node in his left axilla. Chemotherapy did not begin until June 2020. A month later, Boswell died.

“He progressed so fast. It’s ungodly,” said Kineman. “Honest to God. If he would have had the treatment, he would have been with us today.”

The OCO’s report found that the time of diagnosis from when the prisoner first reported symptoms ranged from two to 17 months. The average time of diagnosis was 6.5 months. “The World Health Organization and National Institute for Health and Care Excellence have identified a target of no more than one month from presentation to diagnosis for cancer cases,” the report said. “The target to start treatment is also set to within one month of diagnosis.”

The report found that in six of the eleven cases it reviewed, “the delay was associated with the clinician reaching an incorrect diagnostic conclusion.” In five cases, there was a delay in consultations with specialists, which contributed to a delay in diagnosis. In four cases, there was a delay in scheduling diagnostic studies. Three cases saw a delayed evaluation by a DOC provider, with one case being the result of guards refusing to take the prisoner to the clinic. In two cases, “abnormal lab results were overlooked or not recognized.”

“It is not acceptable for those under our care to experience waits for diagnostics and treatments that could potentially impact their well being,” DOC said in a March 25, 2021 response to the report. It noted that since the report was issued, it had “an 86% reduction in the potentially cancer-related site referrals which are over 100 days past target due dates (from 445 to 49, combined clinical or administrative resolution).”

An administrative resolution is code word for grievances. This is OCO’s third report into delays in cancer diagnosis and treatment: the matter requires the watchdogs to be vigilant. As PLN has reported for over 30 years now, the DOC has a lengthy history of killing prisoners through medical neglect and that does not appear to be changing anytime soon. 


Sources: OCO Investigation of Delayed Cancer Diagnosis & Management, The Seattle Times.

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