Six months before Rian Struckman entered Washington's prison system in August 2018, doctors removed a tumor and one of his kidneys to treat a rare cancer.
A seasonal firefighter from Southwest Washington who struggled with methamphetamine, Struckman had pleaded guilty to theft and burglary charges after stealing a pickup truck from a fire station. While out on bail, doctors diagnosed him with adrenalcortical carcinoma and performed surgery.
But then Struckman entered Washington's prison system -- a system facing increasing scrutiny over breakdowns in medical care for inmates that have led to suffering, deaths and lawsuits.
He and his mother, Stephanie Desparois, tell a story of delays and differing responses by prison officials since a medical scan in February 2019 detected a possible recurrence of Struckman's cancer.
For over a year, Desparois has called and written to prison officials and medical staff urging them to take Struckman's case seriously. "Everybody's sick of hearing my voice," said Desparois, 65, of La Center, Clark County.
Struckman's predicament isn't unique. In December, the state Office of the Corrections Ombuds released a scathing report concluding an inmate at Monroe Correctional Complex, Kenny Williams, died after the Department of Corrections (DOC) failed to provide him with cancer treatment for over a year.
DOC also recently agreed to pay $400,000 to settle a lawsuit over the cancer death of another Monroe inmate, James Thompson, who died Jan. 1. The prison system failed for months to provide him radiation and chemotherapy treatments recommended by doctors, even as Thompson filed grievances over the delays, according to his lawsuit.
As for Struckman, he and his mother say DOC has yet to treat what has been confirmed as cancer.
"I'm in exactly the same position as I was a year ago, when they first found it," Struckman, 42, said in a phone interview last month from Washington State Penitentiary in Walla Walla. "Except nothing's happened," said Struckman, adding that he's suffering chest pains from the cancer.
Desparois on Friday said Struckman is still not receiving any treatment.
Prisons are obligated to provide medically necessary health care to incarcerated persons. But inmates, their families and advocates in Washington have long complained that DOC too often fails -- an accusation buttressed by news stories and investigations over the past year.
In April, DOC fired its top doctor at the Monroe prison after an investigation found inadequate treatment for some seriously ill inmates. The Washington Medical Commission is now investigating seven inmate deaths at the prison.
In November, the Corrections Ombuds office -- created after family members of prisoners petitioned the Legislature for years about faulty medical care and other problems -- issued its first report, noting one in five complaints it receives involve health care.
"We are particularly concerned about the cancer cases we have received," said Joanna Carns, director of the Ombuds office, who cited "bureaucratic failings" leading to delays in care. "Cancer can be a very aggressive disease and needs to be treated aggressively, especially when you have an outside specialist saying you need to treat this urgently."
Mary Jo Currey, DOC's assistant secretary for health services, noted in an interview that inmates frequently enter prison with existing health problems such as diabetes and hepatitis. But she said DOC is committed to improving its care.
"It's always sad when we have a death, of course, and especially when we see a process problem contributed to that," Currey said.
The agency is asking state lawmakers for more money to hire additional nurses, medical assistants and pharmacy staff, and to seek accreditation from a national prison health care association. Gov. Jay Inslee's supplemental budget request being considered by the Legislature this year includes $18.6 million in additional health care spending at DOC.
Lawmakers are also considering other reforms, including Senate Bill 6204, which would require DOC to conduct reviews of unexpected fatalities occurring in prisons. Senate lawmakers voted the bill out of committee. But it missed a key deadline last week to get a vote of the full Senate, and its fate is unclear.
DOC officials say the department has been making improvements internally. The agency created a new position of chief quality officer and strengthened the internal appeals process for patients. They're working on a central registry for cancer patients so headquarters can track cases. The agency estimates it has about 160 prisoners either undergoing cancer treatment now, or who have been treated while incarcerated.
"I am dying."
State prison systems around the country generally struggle to provide adequate cancer care, according to David Fathi, director of the American Civil Liberties Union's National Prison Project.
Inmates often must be sent outside of prisons to see cancer doctors or get treatment, and a shortage of staff or transport vehicles can cause appointments to be delayed or canceled, he said. Prisons in remote areas can also struggle with a shortage of doctors or specialists nearby.
Those and other problems can often be solved with more funding, said Fathi, "But prisons tend to come last in the legislative scramble for dollars."
Any fixes by DOC and lawmakers come too late for inmates like Williams and Thompson, both of whom died after complaining of lengthy delays in care.
Williams, 63, a musician who played electric guitar in bands such as Crazy Texas Gypsies, lived in Kent before pleading guilty in 2016 to two counts of second-degree assault for shooting his girlfriend's son with a .38-caliber revolver, and assaulting her after a night of drinking. He was sentenced to seven years in prison, but had been scheduled for release in December 2020.
In March 2018, a nurse discovered a lump in Williams' breast during an appointment. A follow-up biopsy confirmed cancer, which he was not told about for 13 days. After nearly six months, he was seen by an oncologist, who diagnosed advanced breast cancer and recommended chemotherapy, which he never received.
Williams filed grievances, the internal appeals process for prisoners to raise concerns, to no avail.
"The oncologist told me on Aug. 22nd, 2018 that I needed to start aggressive chemotherapy ASAP and that he would schedule me for the following week. This was now seven weeks ago..." Williams wrote in one appeal. "I am dying, what is holding up the treatment that will save my life?"
A DOC employee responded that Williams had not correctly signed and dated the complaint and that it referred to a problem occurring more than 20 work days in the past, sending it back to him to be rewritten. It was dismissed when Williams didn't send it back within seven days.
Eight months after the lump had been discovered, and three months after the oncologist recommended chemotherapy, no treatment had been done, the ombud's report found. At that point, Williams was past hope, signing a "do not resuscitate" order and requesting comfort measures only.
He died last June "fifteen months after the lump was discovered having never been treated," the report said.
In a response to the ombud's report, DOC said an internal review found "significant process failures" in Williams' case which the agency is trying to correct. The response also noted the primary medical provider for Williams resigned.
Two friends of Williams, Sherman Petersen and Paul "Red" Wilson -- both pastors -- visited him regularly in prison and said they were dismayed at witnessing his decline and DOC's seeming indifference. "I was very discouraged. It seemed like they didn't care," Wilson said.
Williams' family has retained an attorney and is weighing legal action.
"He didn't have to die like that. He didn't have to die alone. He didn't have to die in prison," said Julie Gobble, Williams' daughter, who lives in Kansas.
"He just slipped through the cracks"
In February 2018, James Thompson, then an inmate at Washington Corrections Center in Shelton, felt intense pain in his right ear and sought medical attention. For months, DOC staff treated him for an ear infection, but the pain continued, along with bleeding.
Three months later, in May, he was examined at an Olympia hospital and diagnosed with squamous cell carcinoma, according to a tort claim he filed against DOC. A doctor recommended surgery to remove as much of the tumor as possible, followed by radiation and chemotherapy.
Thompson had the surgery in late June 2018, but DOC did not schedule chemotherapy or radiation treatments, according to records cited in court filings by Darryl Parker, a Seattle attorney who filed a lawsuit on Thompson's behalf last June.
By the time DOC scheduled treatment, in late January 2019, eight months had elapsed since his diagnosis. At that point, his cancer had spread, leading doctors to perform palliative chemotherapy, designed to minimize pain and perhaps extend his life a few more months. He died Jan. 1.
"It seems like he just slipped through the cracks," said Parker. "The medical records show he was supposed to get radiation and chemotherapy, and it was delayed and delayed. By the time we got to him, it was over. There was nothing anybody could do."
Thompson had been serving a life sentence for a pair of 1988 murders.
In a statement, DOC said it agreed to the $400,000 settlement in Thompson's lawsuit, "without admitting any liability, to avoid a lengthy trial and bring closure on this claim for Mr. Thompson's family."
Meanwhile, in Walla Walla, Struckman hopes to get out of prison while he's still alive.
Medical staff initially downplayed the appearance of growths detected in the February 2019 scans, he said. A follow-up scan in May showed the growths increased in size.
In June, a doctor at the prison wrote a memo recounting Struckman's case. The doctor concluded that if the growths were a recurrence, the agency wouldn't try to cure it, because it was likely fatal, according to a copy of the memo that Desparois shared with The Times. Instead, DOC would consider palliative care, which would follow guidelines of the National Comprehensive Cancer Network, the doctor wrote.
That prompted Desparois to apply for extraordinary medical placement to allow Struckman to be released for health reasons, but DOC denied the request. To qualify, state law requires prisoners to be permanently unlikely or unable to be employed, engage in criminal behavior and undertake daily activities without help from others, the agency wrote her.
In a statement, DOC said the agency is unable to speak directly to Struckman's case without a release of information by the inmate, and a comprehensive review with his primary care provider and care team. The agency said it strictly follows national treatment guidelines.
Struckman and his mother say that since December, DOC medical staff have started telling him they would explore surgery to remove the cancer. He received a PET scan earlier this month, according to Desparois, but still hasn't been referred for surgery.
"They keep telling me they're going to do something, and then nothing happens," said Struckman, who is due to be released in January 2022. "I just don't want to die here -- in this place."
Staff researcher Miyoko Wolf contributed to this report.
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