E-Mails Show Attempt To 'Patch Up' a Case Of Medical Negligence

Sunday, May 11, 2008

At the agency in Washington responsible for foreign detainees' medical care, internal documents reveal a tendency to conceal the truth by withholding complete medical records or by offering misleading public explanations. But e-mail exchanges speak for themselves in the death of Francisco Castaneda.

Castaneda's family had fled the civil war in El Salvador when he was 10 years old, but his mother died of cancer before she could obtain legal status for her children. Castaneda began working at 17 and eventually got involved with drugs. After living for nearly a quarter-century in Los Angeles, he was being deported after serving a four-month sentence for drug possession.

In March 2006, immigration officers took him into custody. Medical staff members suspected that Castaneda, then 34, had penile cancer. A lesion on his penis was bleeding and oozing. The staff sought approval for a biopsy, but the Division of Immigration Health Services, or DIHS, headquarters in Washington denied the procedure for 10 months.

Along the way, as he fought deportation, Castaneda filed several grievances. "I am in a considerable amount of pain and I am in desperate need of medical attention," he wrote in June. "I feel that I am entitled to a healthy life."

In July, David Lusche, a physician assistant at the Otay Mesa facility in California, where Castaneda was being held, realized that his grievances were still pending and that an audit of the compound's medical files was approaching. At 2:26 a.m. July 28, he e-mailed a colleague, asking him to retrieve a handwritten grievance from Castaneda that Lusche had left in a drawer in an examining room.

"We need to write something different, or make some amendment, on the Grievance for Francisco Castaneda," Lusche wrote. ". . . Your response starts, 'Grievance not resolved.' Those words are going to attract all kinds of attention during an ICE [Immigration and Customs Enforcement] Jail Standards audit. . . . Could you somehow 'patch up' that Grievance with an amendment then put it in my box. I just want to avoid problems when the Auditors show up."

Anthony Walker, a physician assistant at Otay Mesa, responded at 10:10 a.m. the next day: "But it is true, unfortunately, this is a case where his grievance is correct and I don't blame the detainee."

After pressure from the American Civil Liberties Union, a biopsy was finally scheduled for early February 2007. But immigration officials suddenly released Castaneda from custody days before the surgery, sparing the agency the cost.

When the DIHS medical director, Timothy T. Shack, was asked to review the case, he concluded: "I looked over about 200 pages of medical records for this case. In my opinion, the care provided to this detainee was, and is, timely and appropriate."

One week later after the review, UCLA doctors gave Castaneda a diagnosis of invasive squamous cell carcinoma. On Valentine's Day, surgeons amputated his penis.

In October, after rounds of chemotherapy, he testified before a congressional panel looking into detainee medical care.

"I am a 35-year-old man without a penis with my life on the line," he said. "I have a young daughter, Vanessa, who is only 14. She is here with me today because she wanted to support me -- and because I wanted her to see her father do something for the greater good, so that she will have that memory of me. The thought that her pain -- and mine -- could have been avoided almost makes this too much to bear."

On Feb. 16, 2008, Castaneda died.

U.S. District Judge Dean D. Pregerson denied a government request to dismiss the lawsuit brought on Castaneda's behalf. In his March 11 ruling, the judge said lawyers had "submitted powerful evidence that Defendants knew Castaneda needed a biopsy to rule out cancer, falsely stated that his doctors called the biopsy 'elective,' and let him suffer in extreme pain for almost one year while telling him to be 'patient' and treating him with Ibuprofen, antihistamines, and extra pairs of boxer shorts."

Pregerson added: "Defendants' own records bespeak of conduct that transcends negligence by miles. It bespeaks of conduct that, if true, should be taught to every law student as conduct for which the moniker 'cruel' is inadequate."

-- Amy Goldstein and Dana Priest

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