After his release from federal prison, doctors told Jeffrey Ramirez, 41, that there were no more options for treating his cancer that had been diagnosed—but belatedly treated—while he was still in custody of the federal Bureau of Prisons (BOP). So he passed the time with his teenage daughters and his parents at their home near San Diego until he died on January 16, 2023.

Sadly, Ramirez’s death is not uncommon in BOP, where inadequate and delayed medical care is chronic. Over the past decade, at least 4,950 people have died while in federal custody, a quarter of them where Ramirez died at the Federal Medical Center (FMC) in Butner, North Carolina, one of seven medical prisons run by BOP.

Cancer was the leading cause of death in federal lockups between 2009 and 2020. But many prisoners waited months or even years for necessary treatment, despite exhibiting severe symptoms like unexplained bleeding, lumps or intense pain. For those like Ramirez, the delay proved deadly.

In mid-2020, about six months after arriving in BOP custody to serve a 10-year sentence for drug and weapons convictions, Ramirez noticed a BB-sized lump in his testicle. He put in a medical request slip, but it was ignored. Six months later, the testicle had swollen considerably, so he put in another medical request. That scored a visit with a medical staffer, who ordered testing for a hernia. Shortly after that, on February 2, 2021, a nurse practitioner ruled out a hernia and ordered an “urgent” ultrasound of the testicle.

Yet months passed with no ultrasound. Ramirez put in another medical request but was told he already had a pending test. The process repeated itself until an ultrasound scheduled for September 2021 also didn’t happen. By that point, Ramirez likened the pain to “getting kicked in the groin.” An assistant warden advised him to “trust the process.”

In January 2022, when he finally got the ultrasound, he was immediately admitted to a hospital and diagnosed with late-stage testicular cancer that had spread to his brain and lungs. In March 2022, the testicle was removed and he began chemotherapy, at which point Ramirez was transferred to FMC-Butner. According to the federal public defender who represented him, Ramirez’s case “just fell through the cracks.”

“It seems to be something systemic that’s happening in all of the BOP prisons,” Zandra Lopez added. “When our clients are requesting help, the internal medical staff recognize that these people need to go out to a specialist. But it goes in this hole. And I don’t understand why they’re not being seen. And by the time they do, it’s oftentimes too late.”

BOP claims to meet the same medical standards as independent hospitals at each FMC, though accreditation lapsed in 2021. Meanwhile prisoners, who have a constitutional right to healthcare but no autonomy to access it independently, are dying more often than they should.

Angela Beck, a prisoner in Alabama, waited over eight months for a biopsy after discovering lumps in her breast. By the time she was diagnosed, the cancer had spread.

Michael Derentz experienced repeated delays in care in New Jersey, which contributed to his loss of sight in one eye. He was granted compassionate release in 2022.

Joseph Guadagnoli, a BOP prisoner in West Virginia, complained of various ailments for months and did not receive a cancer diagnosis until it was too late for treatment.

At a BOP lockup in Pennsylvania, Turhan Law suffered nosebleeds for several months before being sent to a hospital. But he wasn’t given treatment plans and was eventually granted compassionate release.

Michael Boughner in Colorado experienced severe headaches for weeks and was eventually diagnosed with brain cancer, but the delay was so long that he died.

These cases reflect systemic issues within BOP, where internal medical staff recognized the need for outside specialist care but often delayed or failed to provide it, even when prisoners had troubling symptoms. The consequences included preventable deaths.

Doctors stress the importance of early detection in cancer cases, which can translate into cure rates as high as 98%. However, for prisoners like Ramirez, who receive treatment only when their disease is advanced, it’s too late for a cure.

The Office of the Inspector General (OIG) of the federal Department of Justice audited BOP’s contract with the University of Massachusetts Chan Medical School, which provides medical services at FMC-Butner. The report highlighted a lack of reliable processes for evaluating quality and timeliness of prisoner healthcare, as well as difficulties in transporting prisoners to off-site appointments due to a shortage of both guards and medical staff.

Over 20% of nurse and paramedic positions at FMC-Butner are vacant, leading to delays in care that risk prisoners’ health and lives. But despite the vast number of people incarcerated in federal prisons, there is limited independent oversight. Accountability offered by courts and OIG is more often reactive than proactive.

A bill pending in Congress, H.R. 3019, the Federal Prison Oversight Act (FPOA), addresses this gap by requiring regular inspections of prisons and establishing an ombudsman within the Justice Department. Introduced on April 28, 2023, FPOA could bring BOP one step toward better accountability, but systemic staffing shortages and inadequate medical care require comprehensive reform to ensure that federal prisoners receive the care to which they are constitutionally entitled.  

Source: NPR News

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