OIG Report
This month, the Department of Justice (DOJ) Inspector General Michael E. Horowitz announced the release of an evaluation assessing the Federal Bureau of Prisons’ (BOP) practices regarding colorectal cancer (screenings for inmates and the follow-up care provided after positive screenings. The DOJ’s Office of the Inspector General (OIG) identified significant operational and managerial shortcomings that the BOP must address to ensure inmates receive appropriate screening and treatment for CRC. The failure to conduct annual CRC screenings, as outlined by BOP clinical guidelines, raises risks and could lead to worse clinical outcomes for inmates, potentially resulting in significantly higher healthcare costs for the BOP. This evaluation was prompted by issues identified in previous unannounced inspections of BOP facilities, as well as the deaths of two BOP inmates, Robert Hanssen and Frederick Bardell, from colorectal cancer.
Prevention of Colorectal Cancer
Early screening for colorectal cancer offers life-saving benefits, including early detection, more effective treatment, and improved survival rates. It plays a crucial role in reducing the incidence of advanced-stage cancer, improving patients’ quality of life, and lowering long-term healthcare costs.
Screening allows for the detection of precancerous polyps and early-stage cancers that might not yet show symptoms. This early detection is crucial because colorectal cancer often develops slowly over several years. Identifying precancerous growths early enables healthcare providers to remove them before they develop into cancer, significantly lowering the risk of cancer. With early detection, treatment is more likely to be effective and may involve less extensive procedures, leading to a better overall prognosis and quicker recovery. I reached out to Dr. Charles Howard who is the CEO of MedAvise Consultants, LLC doing Prison Medical Consulting for individuals with serious medical issues who may be pre-trial, pre-sentence or incarcerated. Dr. Howard told me “the BOP has a poor record of following through on those screenings because of staffing and budgetary issues.”
The Bureau Of Prison Policy Versus Reality
The BOP has its own policy on preventative treatment and included in that is colorectal screening, prostate cancer and cervical cancer. However, staff shortages and funding has been a hurdle for care. Dr. Howard retired as Medical Director at the Miami Detention Center, a BOP facility, said “If a person over 50 years old arrives in prison with a family history of colorectal cancer or a history of colon polyps on a prior colonoscopy they should have a repeat colonoscopy, but the BOP has a poor record of following through on those screenings because of staffing and budgetary issues.”
The OIG concluded that despite the BOP’s guidance for screening inmates at increased risk for colorectal cancer, that the BOP does not have a way to accurately and comprehensively identify the entire increased-risk population due to limitations within the BOP’s Electronic Medical Records System (BEMR). As a result, the BOP’s ability to ensure that increased-risk inmates receive appropriate screening is limited. Those limitations have long term implications for inmates once they leave prison.
The Inmates Who Paid The Price
The OIG looked specifically at two cases, that of Robert Hanssen and Frederick Bardell. In June 2023, Hanssen died of metastatic colon cancer. Hanssen had multiple positive test results indicating the possibility of cancer while incarcerated at Administrative Maximum Facility Florence, yet he never received a colorectal diagnosis or even a colonoscopy. OIG’s report revealed that about 10 percent of inmates (33 of 327) in their sample with a positive colorectal screening result did not have any documented follow-up with any BOP clinical provider.
While at FCI Seagoville, Bardell reported seeing blood in his stool but did not complete a successful colonoscopy for over 6 months. During that period, Bardell had a precolonoscopy evaluation appointment, an unsuccessful colonoscopy, and then a successful colonoscopy that led to his colorectal diagnosis. These appointments occurred weeks to months later than the BOP’s target dates for them. In February 2021, 9 days after being released from FCI Seagoville following a compassionate release order, Bardell died of metastatic colon cancer.
Failure to Conduct Timely Followup Appointments
Timely follow-up after a positive screening result is an important aspect of ensuring positive health outcomes. OIG found that the BOP does not have any established metrics for appropriate colonoscopy wait times, in part because each facility primarily depends on community provider availability. A BOP Central Office official responsible for oversight of Health Services Division programs said that community practice generally aims to complete a colonoscopy within 90 days of a positive screening result. However, BOP Facility Health Services interviewees estimated that the average time between a positive screening result and colonoscopy was 4–8 months. The OIG was able to conduct a timeliness analysis for 133 of the 145 inmates in their sample who had completed a colonoscopy by the time they concluded their data collection and validation in August 2024. OIG found that for those 133 inmates the average wait time between the positive screening result and colonoscopy was 8 months, with a median of 7 months.
BOP Knows It Can Do Better
The BOPf recently announced a new Director, William Marshall III who has a monumental job in front of him. Among the priorities for Marshall and the BOP is to reduce costs while also assuring safety of both staff and inmates. This seems to be another instance where the BOP policy is sound but the execution of that policy is lacking. Even the BOP understands that and BOP Office of Public Affairs reacted to the report by providing a statement, “The Bureau of Prisons (BOP) has taken immediate action to address the concerns in the report. We appreciate the work of the Office of Inspector General (OIG) in this important area.”
“I’m not surprised by the report’s findings,” Dr. Howard said, “the BOP has good health care program statements, but in real life they fall short as reported in the OIG’s report.”
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