This post intends to share an overview of Sam’s cancer timeline to demonstrate how private prison companies cancelling appointments, cutting corners and providing low-quality care can have a serious impact on the progression of cancer and serious health issues.
Sam’s Cancer Timeline
2015, HMP Send
Sam is noticing blood on a semi-regular basis. The doctors think it’s menopause related. Sam’s ex-partner finds a lump inside of her. The prison doctor makes a referral to hospital. The appointment is cancelled due to a transfer from HMP Send to HMP Peterborough on New Year’s Eve.
March 2016, HMP Peterborough
Sam had a hysterectomy under general anesthetic. A small polyp was also removed. Sam highlights the “generous skin tag” (lump) she had found to the surgeon who removes it during the same procedure. The surgeon sent it for testing which comes back as AIN 3.
NB – Anal intraepithelial neoplasia means there are abnormal cells within the lining of the anus. It is not cancer but if left untreated the cells might develop into cancer. In high-grade AIN (AIN 3) the cells look very abnormal – AIN 3 is also sometimes called ‘carcinoma in situ’ or ‘stage 0’. See: http://www.cancerresearchuk.org/about-cancer/anal-cancer/stages-types/stage-0-anal-intraepithelial-neoplasia
The hospital informs the prison that Sam has AIN3 and needs monitoring and treatment. Sam is not informed or shown the correspondence.
April – August 2016
Sam continues to bleed, with regular applications to see the Doctor. Discovered in later correspondence, during this period Sam was meant to have returned to hospital but due to “administrative challenges” there had been a “protracted delay”. Sam later learned at least two appointments had been cancelled by the prison.
Sam attends a hospital appointment where, to her surprise, the Doctor inspects her anal canal. He is in disbelief that she hasn’t been told about the AIN3 and cancer risks. He draws her a simple diagram with little explanation as to what she has and what it means but insists she must have treatment.
When asking for a referral from the doctor in the prison, the prison doctor wrongly reads Sam’s paperwork telling her she has stage three anal cancer (rather than AIN3) and that she has a 50% chance of survival. This is obviously incredibly distressing (and was unnecessary stress).
Sam returns to the local hospital at the end of August for tests and is told she needs to go to Homerton Hospital in London for specialist treatment. HMP Peterborough fails to organise this or follow this up, and so Homerton is only informed in late September.
The prison keeps telling Sam she will go to hospital “soon” yet do not communicate when this will happen. No information, advice, or support is given about Sam’s condition. In mid-September, the Doctor finally realises their mistake about the AIN3-Stage 3 and informs Sam. The Clinical Head of Healthcare in the prison tells Sam she does not need treatment and that she simply needs to go back to the hospital for six-monthly inspections. Sam contests this saying the doctor she spoke to in hospital told her she needed treatment.
Sam’s then solicitor writes to the prison threatening legal action if treatment is not organised. In the middle of the night, a photocopy of some correspondence is pushed under Sam’s cell door. It is a letter between the surgeon from Peterborough hospital and Dr. Myura Nathan at Homerton Hospital (the specialist anal cancer centre) from September saying that Sam needs to be sent to Homerton Hospital for high-risk anoscopy surveillance.
Sam finally gets to Homerton Hospital on the 1st November and meets Dr. Annede-Masi. She has an anoscopy where they are hoping to find just AIN3 that can have future laser treatment. Instead, they find a small cluster of tumours. Three biopsies were taken and Sam is informed she will receive the results in three weeks.
The hospital sends the results to the prison on the 23rd November. Sam is left waiting for 16 days while the prison denies they have received anything and fail to communicate the results.
Sam receives the results on the 9th December. Of the three biopsies taken, there are no abnormalities on two of them. The third biopsy taken from the anal canal revealed only HPV related changes but as the Doctor suspected, she could not get behind the lesion that she felt there, meaning it is necessary for Sam to go into theatre. The anal cytology showed high-grade changes of AIN2 and AIN3. She was referred back to the hospital to have more biopsies taken.
After nearly two months of waiting, Sam is informed on the 18th January by nurse Amy Flatters that her appointment for more biopsies has been canceled because “the prison has a limit of how many people they can take out a day and can’t go over this quota”. In speaking to the hospital the following day, one of the nurses discloses that they have been trying to get Sam in for ages and the “prison keeps blocking dates because of staffing”.
Sam is able to call the hospital directly (the prison later take the number off of her allowed numbers with no warning or written reason). They tell her due to the cancellation she is likely to need to wait another 4 – 8 weeks for an appointment.
On the 3rd March, Sam is told she will go to hospital ‘any day now’. Apparently, the hospital had communicated with the prison it is very likely she will need the 6-week treatment of chemoradiotherapy. Her psychiatrist informs her that the prison is talking about moving her to HMP Bronzefield, which is fractionally closer to the specialist hospital. She tells her that there is a risk the chemotherapy drugs will contraindicate with her bipolar medication. Again, none of this is communicated in writing and Sam is unclear about where these treatment decisions have come from.
On the 14th March, Sam sees the prison doctor who says Sam will go to the hospital “this week or next week”. After numerous complaint letters, the Governor of HMP Peterborough replies saying it was the security department that had cancelled her appointment, not the healthcare department who apparently had given Sam only “quality support and information” during this time. The Governor also mentions an appointment being cancelled at the Hospital because of a Doctor being sick, yet we are unable to confirm this.
On the 17th March, Sam finally gets to Homerton Hospital for further biopsies. The doctor she sees is very angry about the lack of information communicated to Sam and the canceled appointments. She offers to respond to the letter from the Governor. She is told she will go back to the hospital in two weeks for the results and to discuss treatment options.
Due to staffing at the hospital supplying testing to Homerton, the biopsy results take longer than expected. On the 25th April, the results finally come back from the 8 biopsies and a number of them are cancerous.
The prison doctor says they are awaiting another email from the hospital about treatment options and that Sam may need to return for further investigations before any treatment.
Sam goes to hospital on the 5th May for scans. On the 12th May, Sam is told she will see the consultant at Homerton Hospital the following Friday. Unfortunately, this meeting was cancelled due to the cyber attack against the NHS. The multidisciplinary team meetings where a group of specialists discuss treatment options, only take place every two weeks. Therefore, the discussion of Sam’s treatment plan is postponed for two weeks due to the cyber attack.
Sam repeatedly asks Healthcare staff at HMP Peterborough for the outcome of the meeting and information on her treatment plan. Agency staff say they do not wish to disclose the results, and so Sam must wait until the Doctor returns from holiday.
Finally, Sam is able to speak to a nurse at Homerton Hospital directly on the phone. The scan shows that the cancer has not metastasized, which is good news. However, there was disagreement between two consultants and so they wish to take further biopsies.
Sam had still not had the written correspondence from the hospital, and when asking the prison doctor, she was told “I’m a busy man you know”.
On the 21st June, Sam had a pre-op phone call with the hospital and was told her appointment had been “pushed back” to the 14th July. No reason was given for the delay, so it is unclear if this is due to the hospital or the prison.
On the 14th July, Sam went to hospital for the further biopsies. The team informed her that the tumours are too complex now to be treated with an operation or laser treatment and that it is certain she will need to have chemoradiotherapy.
Sam was prescribed antibiotics and painkillers by one of the doctors at Homerton Hospital. On arriving at HMP Peterborough, the prison would not allow the prescription. Sam puts in a written application to see the Doctor (a different doctor to the one on duty when Sam arrived).
Sam develops a post-operation infection. Over a number of days, Sam had experienced a high temperature, lost over 11 pounds, and been repeatedly vomiting. The bleeding from her anus increased significantly, as well as her pain. She is not treated in the night because of another girl attempting to take her life in the prison.
With fear of sepsis, an outside friend calls an ambulance for Sam. The ambulance department say they do not go to the prison unless called by the prison. No further action is taken by them to find out if she is receiving medical attention.
Sam, who had not seen a doctor for more than three weeks, is told that none of her applications had been received. The doctor discloses that he believes one of the nurses is responsible but is unable to prove it, and tells Sam she is not the only person targeted in this way. Sam is finally given appropriate painkillers and antibiotics.
On the 31st August, after 6 weeks since the biopsies, nothing has been communicated to Sam about her treatment or next steps. She calls the hospital and is met with either no answer, or responses that the nurses are busy and unable to speak to her. Her next of kin calls the hospital, which tells her that three of the doctors are on annual leave for 2 weeks and this will impact Sam’s treatment.
No information is given to Sam regarding when she might be returning to the hospital for treatment. No communication is received from the hospital. Sam calls Homerton Hospital and speaks to a male nurse who tells her he will not tell her anything because she is a prisoner. Sam emphasizes she does not need to know exact dates (prisoners are never told exact dates they have appointments due to security reasons) but only wishes to know what the treatment could involve, any side effects and so forth. The staff member continues to speak in an aggressive and dehumanising manner. In distress, Sam ends the phone call.
The hospital’s phone number was then removed from Sam’s pin (the list of approved numbers that she is able to call) without warning or reason.
Her next of kin complains to the PALS service at Homerton Hospital (the Patient Advice and Liaison Service ) asking someone from the hospital to please be available to communicate with Sam as a patient, expressing the prejudice experienced when calling for information for Sam. Nothing happens despite further follow up calls.
Sam is informed at the beginning of October that she will go to hospital “at the very end of October”. She does not know if this is for more assessments, or if this is for actual treatment, or what this treatment might involve.
Later in the month, she is told that she will be having laser treatment before chemoradiotherapy. She does not know what laser treatment involves or how long it lasts, however, is told following the treatment she will need to wait 6 weeks before starting chemoradiotherapy.
On the 20th October, Sam is told she has to pack her bags and they are moving her to another prison. The prison is HMP Foston Hall in Derbyshire, approximately 3.5 hours away from Homerton Hospital in London where she is due to start her treatment the following week.
The Head of Healthcare who had signed off the transfer tells Sam that “it’s only down the M1 to get to hospital” and is smiling as Sam is being taken.
Sam’s next of kin had organised a visit with a mentor from an Anal Cancer charity which had to be cancelled also due to the transfer.
On arriving at the new prison, Sam tells the doctor about her cancer and imminent appointment. They tell her she “doesn’t have a chance in hell” of getting to it. When later complaining to a Governor, the Governor says “we’re very good at getting people to appointments, don’t worry”.
Sam’s solicitor contacts the prison on the 30th October warning of legal repercussions if Sam’s treatment is affected by the transfer.
On the 31st October, the date of Sam’s appointment, she is not taken to the hospital. There is no communication about it being rearranged. Sam later learns that neither HMP Foston Hall, nor HMP Peterborough communicated with Homerton Hospital.
On the 3rd November, Sam finally has an appointment with the main doctor at HMP Foston Hall. He informs her that they are in communication with the hospital and are rearranging the appointment. She has been referred to the hospital local to the prison for a colonoscopy in two weeks because they are concerned about the source of bleeding. The doctor also went through a lot of correspondence between Homerton and HMP Peterborough that was meant for Sam that she had never even seen.
She does not know when her treatment will begin.