Cancer Cell
The medical "care" that women get at Carswell’s prison hospital can be fatal.
By Betty Brink
“Our hospital and staff provide inmates with medical care that is comparable to community standards.” — Deborah Denham, executive assistant to the warden, Federal Medical Center, Carswell
The nurse pushed open the door to the hospital room, and the small woman in the bed looked out into a world that was beyond her reach. Her legs were shackled to the bed rails, allowing her to move only to the nearby potty chair and back. A mass of matted dark auburn hair formed a halo around her head, which was held stiffly upright by an orthopedic collar. She was sitting up, her swollen abdomen visible under the sheet. As she turned awkwardly, her eyes met those of a reporter standing in the hall; she looked like a frightened child who did not understand what was happening to her.
It was Aug. 8, and Darlene Fortwendel, 49, an inmate at the Carswell Federal Medical Center for women had just been told by a Huguley Hospital oncologist that there was no hope for her recovery from a rare form of liver cancer that had gone untreated at Carswell for six months. By the time she was examined at Huguley, the cancer had metastasized to her bones. Even worse, the oncologist found several malignant tumors growing on her spine that were causing partial paralysis in her upper body, a process that could hasten her death.
“She won’t be able to breathe,” her sister Angie Garrett said angrily a few minutes later. “We are devastated. This is a horrible way to die.” Her sister had been sent to federal prison in 2003 with a 37-month sentence for embezzlement, not for some heinous violent crime. But when Darlene was transferred to Carswell — the only women’s hospital in the federal prison system — it might as well have been a death sentence. “My sister’s not a murderer,” Garrett said, “but this Carswell place has killed her just the same.”
Fortwendel was a bank officer in the small town of Tell City, Ind., when a gambling addiction drove her to embezzlement. Originally sent to a prison in Illinois, she arrived at Carswell in February with less than a year left on her sentence — and with a diagnosis of metastatic liver cancer already in her records. Nonetheless, it took the Carswell medical staff five months to determine that the cancer was hepatocellular carcinoma, a rare type of liver cancer that is often successfully treated when found early.
But it wasn’t treated early. While Carswell doctors dithered, they ordered no treatment, and the tumor on her liver continued to grow. By July, when the staff arrived at their diagnosis, the tumor was so large it made her look pregnant. Even then they ordered no treatment, not even pain medication. By the time she was sent to Huguley — a hospital under contract with the Bureau of Prisons to provide specialized services not offered at Carswell — she had been suffering for a week from intense pain in her upper body that left her unable to use her arms for even the simplest tasks, Garrett said. Her fellow inmates had to dry her when she stepped out of the shower and to help her get dressed. “They heard her crying and took care of her,” Garrett said. “It’s a crying shame when you’re in the hospital and the only people there to take care of you are the other patients.” For the last week, she said, her sister “became very pale, she couldn’t eat, and she was in terrible pain.”
Fortwendel was on the infamous fifth floor at Carswell, where women are sent who are considered by the staff to be too “healthy” to be on the medical ward a floor below. Unlike the med floor where there are nurses on duty and the patient can be monitored during the night — as in any other hospital on the outside — the women on the fifth floor fend for themselves. They clean their rooms, wash their clothes and bedclothes, get their own food from the cafeteria, and go to the medical floor below for their daily medicines.
Mike Truman, Bureau of Prisons public relations officer, said that the fifth floor is an “outpatient type” ward for inmates “who are medically stable, able to function on their own and take care of themselves.” While many are dependent on some kind of “medical device” such as oxygen tanks and wheelchairs, he said, all are expected to sign up for work assignments based on their abilities. Truman said that working is a way “for the women to pass the time. It can be very boring in a hospital.”
Yet these women had been sent to Carswell with critical illnesses, their families assured that they would get care “comparable to community standards.” Fortwendel had cancer; Nicole Vasquez, who died in her bed there on Aug. 1, had lupus and was recovering from heart surgery. Many are brittle diabetics; some suffer from congestive heart failure, others from multiple sclerosis. More than 40 are in wheelchairs, Garrett said, and the six elevators are constantly breaking down. She visited her sister several times and talked to her almost daily, finding out as much as she could about the care at Carswell. When the women’s illnesses flare up or they are in pain, Garrett said, they have to go down to the main floor, where they stand in line to see a physician assistant who decides if they need to see a doctor. “When Darlene began to be in so much pain, she stood in line an hour and a half, crying and begging for pain medicine,” Garrett said. She got none.
Deborah Denham, executive assistant to the Carswell warden, refused to comment on particular cases, citing privacy concerns — despite the fact that Fortwendel had provided a reporter with a privacy release. Denham did say that from time to time, “we have had problems with the elevators, but now three are working. We have never been without one operating elevator.”
“It’s a terrible place,” Garrett said two weeks ago. “I can’t wait ’til she gets out of there.” And indeed, since early July, Garrett and her family had been waging a campaign to get Fortwendel sent home to Indiana under the Bureau of Prisons’ “compassionate release” program. But by the time Fortwendel was seen by the doctors at Huguley, that effort had become an issue as malignant for the bureau as the untreated tumors were threatening to be for Fortwendel.
Fortwendel’s family was convinced that she could still be helped if they could just get her out of Carswell. Even by the bureau’s strict practices of granting releases only to terminally ill patients, Fortwendel should have qualified immediately, and by mid-July her application even had the support of the prison’s chief medical officer, Beatriz Parra. However, a month after Parra recommended the compassionate release, Fortwendel was still in Carswell, still without treatment, as her request moved at an agonizing crawl through what a former Justice Department attorney called the “heartless, inhumane, bureaucratic indifference” of the Bureau of Prisons. The process, Garrett was told, could take three months.
But Fortwendel’s request was being pushed by a support network that few prisoners have: a sister who was raising hell daily, a U.S. senator who’d taken up her cause, a lawyer who was filing motions, the judge who sentenced her, and even officials of the bank from which she stole the money. An aggressive Evansville reporter wrote investigative stories on Fortwendel’s shabby treatment at Carswell, creating a public relations nightmare for the bureau.
On Aug. 10, two days after being admitted to Huguley, Fortwendel was flown by air ambulance to Indiana, her compassionate release granted in record time. “I couldn’t accept a three-month wait,” Garrett said later. “She could have been dead by then. What kind of ‘compassion’ is that?”
In Tell City, Fortwendel was reunited with her mother, two sons, and grandchildren. Ten days later, she was recovering from surgery at the University of Kentucky Medical Center, where doctors had removed the tumors on her spine that were slowly paralyzing her. Soon she will undergo chemotherapy and radiation treatments to shrink the tumor on her liver. “Now we have hope that her life can at least be extended a bit and that she won’t die by suffocation,” Garrett said. “We’ve gotten more done here in six days than was done in six months at Carswell.”
As horrifying as Fortwendel’s story is, it’s not unique. Since 1999, Fort Worth Weekly has documented case after case in which women have alleged gross medical neglect at Carswell, including unexplained delays in treatment that led to early deaths — almost all those claims substantiated by the hospital’s and the Bureau of Prison’s own records. The cases included that of Valerie Virgl, a burn victim and amputee sent to recover from multiple surgeries whose neglect became so life-threatening that the judge who sentenced her asked then-Attorney General Janet Reno to move her to another hospital because her treatment at Carswell amounted to “cruel and unusual punishment.” Beverly Joseph almost died after a physician assistant misdiagnosed her congestive heart failure as a urinary tract infection. Brenda Woodruff’s vaginal cancer was misdiagnosed as uterine cancer by an ob-gyn doctor even though she had had a hysterectomy a year before — ordered by the same doctor.
And there was Janice Pugh, whose case was an early forerunner to Fortwendel’s. Pugh entered Carswell with a known history of lung cancer. Six months before her sentence was up, she began coughing up blood. The Carswell doctors ignored her symptoms, put off tests, told her the results were inconclusive. She was never treated. Fourteen days after she was released from Carswell, doctors at the University of Southern Alabama Medical Center found cancer in her chest, right lung, and brain. Two months later Pugh was dead, at age 52. “Your mother was very neglected,” her Alabama doctor told Pugh’s grieving children.
As for Fortwendel, her prognosis is still extremely bleak. “Liver cancer, no matter when it is found, is nearly always fatal,” a Huguley doctor told the Weekly. Still, she’s upbeat these days. “I want to live long enough,” she said, “to get on my feet and get in front of a senate committee to tell them the truth about Carswell.”
There are no U.S. Senate hearings planned to look into the Carswell hospital — which, ironically, was opened in 1994, after an earlier women’s medical facility in Lexington, Ky., was closed following a devastating report on the inadequate conditions and care there. Garrett and Fortwendel hope to convince Sen. Richard Lugar of Indiana, whom Garrett convinced to champion her sister’s compassionate release, that a new investigation is needed.
When Dunham, the warden’s assistant, was asked if there are any other investigations into the sisters’ charges of medical malpractice at Carswell, she said, “I’m not at liberty to talk about any investigations.”
It’s not like the doctors at Carswell didn’t know Darlene Fortwendel had cancer. When she was transferred there from the Greenville Regional Hospital, Fortwendel brought with her a thick file of medical reports showing an unambiguous diagnosis of “metastatic cancer of the liver” of unknown origin. But when Carswell warden Ginny Van Buren wrote to Sen. Lugar about Fortwendel’s case, the previously documented cancerous lesions suddenly became “an abnormal lesion on the liver that was benign.” The cancer was miraculously cured by the stroke of a pen.
Fortwendel, of course, wasn’t really that lucky.
The journey that would take the small-town Indiana woman into the Carswell bureaucratic maze began in 2002 with Fortwendel’s tearful admission to her sister that, to feed her gambling problem, she had embezzled $750,000 from the Old National Bank in Tell City where she was a bank officer. Angie Garrett, shocked and honest to a fault, talked her sister into turning herself in and taking her punishment. “We knew she had a gambling problem,” Garrett said, “but we had no idea how deeply in debt she was.”
Garrett, Fortwendel’s two grown sons, and her 82-year-old mother stood by her. “We just wanted her to get this behind her, take her punishment, and get help for her addiction. She planned to help other addicted gamblers when she got home,” Garrett said. Fortwendel was convicted in 2003 and sentenced to 37 months in a minimum-security prison in Greenville.
Then in late January of this year, with less than a year left on her sentence, Fortwendel was sent to the Greenville hospital suffering from abdominal pain and “intractable nausea and vomiting.” Doctors performed CAT scans and a liver biopsy and found “multiple metastatic lesions” in her liver. There was a primary cancer elsewhere in her body, they then believed, that had metastasized to her liver. Tests showed her bones were free of the disease.
But before the Greenville doctors could do any follow-up, and despite her sons’ request that the Bureau of Prisons keep her in Greenville for treatment close to their home, the agency whisked her off to Carswell, where her family was assured she would get care “comparable to community standards.”
Fortwendel’s medical records from Carswell reveal a litany of missed opportunities to isolate her cancer’s source and begin timely treatment. The records confirm Fortwendel’s charge that the prison doctors ignored the diagnosis that sent her to Carswell in the first place, putting her instead through a series of medical missteps that would be farcical if they had not been so deadly.
Carswell sent out her first blood work on Feb. 16; four weeks later she was told she had lymphoma, a cancer of the lymphatic system, not liver cancer. “She was clearly upset, crying, shaking, and unable to contain her emotions,” prison psychologist Leslie Faris wrote on March 15.
Two weeks later, on March 30, Fortwendel was told by the medical staff that she might not have cancer at all. Faris wrote that day that Fortwendel was tearful, concerned that she “has been here two months with no treatment if, in fact, there is cancer.”
Then in mid-April, after undergoing a PET scan earlier that month, Fortwendel was standing in line at the cafeteria when the prison’s clinical director, T. J. Ballom, approached and told her that she had seen the latest test results and that Fortwendel should start the paperwork for compassionate release. The PET scan report showed cancer “in her bones and multiple masses on her liver.”
“I thought I was going to collapse,” Fortwendel told Maureen Hayden of the Evansville Courier & Press, who has written extensively about her case. “I knew that only inmates with six months to live qualified for early release.”
The cafeteria “consultation” resulted in a near-nervous breakdown for Fortwendel. Her medical officer called Faris in to help in a “crisis intervention” session with Fortwendel on April 21. “She expressed frustration about the system and shock about the diagnosis,” Faris wrote.
Then on May 24, a liver biopsy showed that Fortwendel had a malignant tumor of unknown origin. By June 2, the medical reports were referring to her disease as “advanced stage liver cancer.” Inexplicably, even then, no one on the Carswell staff sent her to an oncologist, and no treatment was begun.
Finally, on June 30, Fortwendel saw local oncologist Robin Young, who told her that the origin of her cancer was “likely breast or ovarian,” Fortwendel said. Then later, it was, well, maybe not. “[S]ubsequent markers for breast cancer were negative,” Parra wrote in the medical records. Young did not return calls from the Weekly.
On July 8, just as Garrett’s campaign to get her sister released was heating up, Carswell sent Fortwendel’s lab work and her history to the Mayo Clinic, which quickly sent back the diagnosis of hepatocellular carcinoma. The liver tumor would have been curable, Garrett was told by a University of Michigan Medical School specialist, if it had been “aggressively treated when it was small.” With the cancer untreated, Fortwendel’s life expectancy would be approximately six months.
From that date until she was sent home, Fortwendel received no treatments, not even pain medication, she said. “All I ever got out there was Paxil for depression and my blood pressure meds” — medications that had been prescribed before she arrived at Carswell.
Carswell’s worst sin, according to Fortwendel’s lawyer Jeff Lantz, was in never ordering any kind of treatment even when the hospital’s own test results clearly indicated she had cancer. He made that failure a centerpiece of his motion for her release from Carswell. “This is the only case I’ve had like this,” Lantz said. “Darlene is a nice lady who clearly did wrong, but what the prison is doing is unconscionable.”
Garrett also learned just how far Carswell personnel would go to misrepresent — she calls it covering up — the hospital’s failure to treat her sister. In June, Garrett wrote Lugar a passionate plea for help, explaining her sister’s plight and telling him of the prison’s controversial history, including some unexplained deaths and incidents in which inmates had been sexually assaulted.
Lugar wrote to Warden Van Buren for answers. Her reply, dated July 7, said, in part, that tests were performed on Fortwendel at Greenville to “rule out a malignant lesion” and that results revealed only an “abnormal lesion that was benign.” Even the doctor who ultimately recommended that she be given compassionate release misrepresented Fortwendel’s medical history, though not quite as blatantly as Van Buren. In spite of the Greenville medical records in her possession, Parra wrote on July 12, in a medical history of Fortwendel’s case for the prisons agency, that the Greenville doctors found kidney and liver lesions “suspicious” of cancer.”
Van Buren’s executive assistant Denham said the warden wouldn’t comment on Fortwendel’s case because of privacy considerations. As far as the warden’s answer to Lugar’s letter, Denham said, “We always answer congressmen’s and senators’ letters. It is normal procedure.”
(None of the Carswell staff has been allowed to talk to the Weekly about Fortwendel’s case, even though she gave permission to do so when she was at Huguley. The Weekly was not allowed to interview Fortwendel at the hospital or while she was in the prison. Since 2000, when the paper’s first story on Carswell was published, this reporter has been banned by the Bureau of Prisons from the hospital grounds.)
In the last 12 months, 17 women have died at Carswell, according to bureau spokesman Mike Truman. Several current inmates told the Weekly that the number is 20. But some deaths don’t make it into the official count — like that of Linda Fenton, 34, who died in 2004 at an outside hospital where she was taken after Carswell staff claimed to have found her near death from a suicide attempt in her cell. She died at Fort Worth’s Osteopathic Medical Center after lying in a coma for eight days. In spite of the fact that she never regained consciousness, she was shackled to her bed and watched over by two guards. “What did they think she was going to do, run?” her angry brother Paul D’Antuono asked. All her family knows is that two days before she was due to be released, after spending seven years at Carswell on a drug-related charge, Fenton was put in solitary confinement because the doctors believed she was suicidal. “If that were true, they didn’t protect her very well,” D’Antuono said.
Her family, in Florida, does not believe she committed suicide. “She was calling home, happy to be getting out,” D’Antuono said. “She had already enrolled in college and was ordering things for her apartment. Those weren’t the actions of someone planning to kill herself.”
Nicole Vasquez is another young woman who will never make it home. She died alone in her room on the hospital’s fifth floor on Aug. 1, two months before she was scheduled to get out. She was 27. Truman said records show she died from septic shock.
Fortwendel and four other inmates still in the prison hospital — all of whom asked not to be identified — recounted a heartbreaking version of Vasquez’ last days.
Speaking from her sister’s home shortly after her release, Fortwendel explained that Vasquez had been serving time in a federal prison in Connecticut for a drug-related crime when she became ill last year. She had been diagnosed with lupus when she was young and had had heart problems, Fortwendel said. At a Connecticut hospital in 2004, Vasquez had heart surgery and was transferred to Carswell for follow-up care. She was put on the fifth floor and quickly became part of the “family” of women there who help and support each other.
A week before she died, Fortwendel and the inmates said, Vasquez became sick with what seemed to be an upper respiratory problem, aches, and fever. She went to sick call and was given medications to take by mouth, which Fortwendel and the others claim did no good. From July 25 until Aug. 1, she made numerous trips, sometimes five a day, the women said, to the medical floor asking for help. Fortwendel said Vasquez was always told “to go back upstairs and take your medicine.” On the day she died, Vasquez reportedly made four trips to the medical floor, still begging for help. “She was very sick, but she was always sent back,” Fortwendel said.
Tracy Sanchez, a 35-year-old prisoner from Ogden, Utah, has the kind of medical problem that Carswell’s history suggests it doesn’t handle well. She has a rare kidney disease and needs a kidney and liver transplant. In letters from the prison, she and one of her fellow inmates have written that she has a severe stage of primary hyperoxaluria, a rare genetic disorder. Officials say the agency doesn’t have a policy prohibiting transplants, but in the 11 years since the Carswell hospital was opened — on the site of an earlier men’s hospital — no transplant has ever been approved for anyone there. Sanchez’ only hope is early release. Unfortunately, Carswell’s history of granting early releases is almost as skimpy as its granting of transplant requests.
In the past two years, Denham said, Carswell, which averages a medical inmate population of about 500 each year, has granted five compassionate releases.
Most of the women at the Carswell hospital are in prison for nonviolent crimes, many of them drug-related. Most were sent to prison after mandatory sentencing took away judges’ discretion in the 1980s. Even a tough old prison-system veteran like Joe Bogan, whose father was a warden and who oversaw Carswell for six years, told the Weekly in 1999 that mandatory minimum sentencing is unfair and targets the wrong people. “Many of these women [at Carswell] should at the least be in a halfway house close to home, close to their children, or simply have been given probation,” he said.
Prison reform advocates have long asked why so many seriously ill women (and in other prison hospitals, men) who have not been convicted of violent or terrorist crimes are being held in a prison setting in the first place — locked behind a razor-wire fence; sent to solitary without their medications; shackled to hospital beds when they are dying, unconscious, or unable to walk.
Why, if there are families or friends or halfway houses or hospices available, isn’t compassionate release the norm rather than the exception in the rulebook of the Bureau of Prisons? The federal criminal code allows a court, on a motion of the director of the Bureau of Prisons, to reduce a sentence for “extraordinary and compelling” reasons — not only in cases where death is imminent.
That question is one that Margaret Love of Washington, D.C., a former Justice Department lawyer, has been “agitating about” for years. Love, who formerly had the job of reviewing early-release requests from federal prisoners, now chairs the American Bar Association’s Correction and Sentencing Committee. She said that if the law was used as the words intend, it would apply to a broad range of cases. And it would relieve the federal system of at least a small portion of its burgeoning population which now tops 186,000. But more importantly, Love said, it would make this a more humane and compassionate society.
Love found the numbers of deaths that have occurred at Carswell over the past year “astonishing.” These were women who might have benefited from a broader interpretation of the early release statute, she said.
In 2003, under Love’s guidance, the ABA adopted a new policy on sentence modifications, stating in part that the criteria for early release should be broad enough to “allow consideration of such non-medical circumstances as old age, changes in the law, heroic acts, or extraordinary suffering of a prisoner ... and family-related exigencies,” such as a dying child, a dying parent, the orphaning of a child. “If a spouse dies while a mother is in prison and a child is suddenly left alone, that would be extraordinary and compelling,” she said.
She has lobbied the U. S. Sentencing Commission for years to adopt specific guidelines that would put some of these types of contingencies into writing. “Without direction about what situations might warrant revisiting a sentence,” she wrote in 2003, “corrections officials are reluctant to expand the reach of ‘extraordinary and compelling’ beyond the clearly identifiable imminent death.”
Love said that the prisons agency “is the only one that has the ability to bring these [requests for sentence reductions] to the courts, and so far the heavy hand of the BOP is keeping these things from happening. The courts are ready, most U. S. attorneys are ready. ... But the BOP regards itself as a jailer, nothing more, and it has clamped down. No parole, no early release, no nothing. ... It is cruel.”
Mark Varca, head of FedCURE, a prison reform group headquartered in Florida, wrote in an e-mail that he has never heard of compassionate release being granted to anyone other than a prisoner with a terminal illness and less than one year to live. “Sadly, it is more common than not that dying inmates are released only when they are in their last days of life.”
The Fortwendel case, however, could be a turning point, Love said. It has focused attention on the issue more than any others in recent years, and it got the attention of a powerful senator and a federal judge. And Love brought it to the attention of the Sentencing Commission.
Angie Garrett is ready to carry this fight as far as she can. “I was not political or even very socially aware before my sister got caught up in this awful system,” she said. “I was just an ordinary housewife from Tell City. Now I want to tell everyone what is happening to these women. This system has got to change. And I’m ready to spend the rest of my life working to change it. I hope Darlene will live to help me, but if she doesn’t, I want to make sure that her death will have some meaning.”
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