Suit: Terminal cancer spread as prison neglected Delaware inmate's pleas

Steven Sipple weighed 240 pounds and was in good health when he entered James T. Vaughn Correctional Center in June 2015.

Two years later, in April 2017, he walked out of prison weighing 146 pounds.

For 14 months, he suffered severe pain. According to a lawsuit he filed in Delaware Superior Court, he made more than 15 written requests for medical attention. Many were disregarded, and the times he was seen, he said his symptoms weren't taken seriously. At the time of his release, a leaking, bleeding one-inch tumor protruded from his rectum.

Hours after his release, Sipple was examined at Kent General Hospital in Dover where he was told to make appointments with an oncologist, surgeon and hematologist, a doctor who treats diseases of the blood.

His diagnosis was terminal. Cancer that started in his colon and rectum had spread to his lymph nodes, liver, lungs and other parts of his body. Doctors told him he had only months to live.

Sipple and his attorney say the terminal cancer could have been prevented had Sipple received proper care in prison, findings detailed in multiple court filings.

Prison advocates, attorneys and inmates say the lack of care provided to Delaware prisoners is not unique to Sipple and has been documented for more than 10 years.

"Based on the first time he reported symptoms," Sipple's lawyer Bruce Hudson said, "our expert said this would have been totally curable (had it been caught when Sipple initially sought treatment)."

Sipple is hoping aggressive chemotherapy can prolong his life. The tumor recently began to grow again when a previous form of chemotherapy stopped working.

"The tumor was so big that it actually was shutting my colon down," Sipple said through tears earlier this week at his quiet Felton home.

"This all could have been avoided."

Connections Community Support Programs Inc., the contracted health care provider for the Delaware Department of Correction, is the only named defendant in the suit.

In court filings, Connections has denied the allegations. Connections officials declined to comment on the suit this week.

"In my whole practice, this is the most egregious, most neglected case," said Hudson, who has represented several medical negligence claims regarding prison health care in Delaware. “He had every sign and symptom of colorectal cancer.”

In 2006, federal authorities were called in to oversee Delaware's prison healthcare after The News Journal published a months-long investigation. Among the cases featured in the newspaper's series was that of Anthony Pierce, an inmate who died from a brain tumor that grew to the size of a second head.

Hudson said he struggles to understand how this lack of care still takes place.

The DOC was under a federal monitor for six years as a result of the negligent findings in 2006.

Sipple was serving a two-year sentence at Vaughn after pleading guilty to one count of unlawful sexual contact with a person under the age of 16.

Court documents obtained by The News Journal show that Sipple admitted to inappropriately touching a young girl. He was charged with 25 counts of unlawful sexual contact and one count of continuous sexual abuse – but in a plea deal was convicted of just the one charge.

Sipple's lawsuit does not dispute the charge or argue that he shouldn't have done time in prison. But he said he also wasn't sentenced to death.

"By no means do I feel like (prison) should be the Taj Mahal," the 48-year-old said, "but you should be treated like a human being."

In addition to a medical negligence lawsuit, Sipple also filed a breach of contract suit against Connections for not providing the services outlined in its contract and request for proposal with the Department of Correction.

“(Connections)’s acts, in depriving (Sipple) of his rights under the contract to medical necessary care, were intentional, negligent, reckless indifferent, willful, wanton, malicious and outrageous,” the lawsuit said, adding that the company acted in “conscious disregard” for Sipple’s safety and healthcare needs.

The state recently announced that an outside team of experts will review the prison's policies surrounding non-emergency health care requests or the "sick call" process – the very process Sipple claims failed him during his time at Vaughn.

This comes at the recommendation of an independent report that reviewed what led to a fatal uprising at Vaughn last year that ended with one correctional officer dead and two others badly beaten.

The state will also hire an outside organization to review Vaughn's grievance process – what is supposed to function as due process for inmates with frustrations, concerns or complaints. A report on these findings is expected in July.

The DOC has not had a permanent medical director since long-serving Dr. Vincent Carr retired this summer. He continues to serve on a "casual/seasonal" basis, according to the prisons, but the state is seeking to fill his six-figure position.

Prison advocates like the Rev. Christopher Bullock, pastor at Caanan Baptist Church near New Castle, say the poor medical treatment continues today. Letters received by his office detail frustrations with a lack of substance abuse treatment, health care and “lack of access to medical attention in an expeditious way,” he said.

“People are still concerned,” he said. “Prison should be about redemption and rehabilitation.”

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The brother with two heads

Just over five years ago, the DOC was released from an agreement with the U.S. Department of Justice in which the state agency was supposed to have improved health care for its prisoners.

That agreement was prompted by a six-month investigation by The News Journal that uncovered the case of Pierce, who became known as "the brother with two heads." Pierce, who was being treated by a private contractor the state hired to handle inmate health care, Correctional Medical Services, died from the brain tumor in 2002.

CMS later settled a wrongful-death lawsuit filed by Pierce's family, who said his condition was ignored as it worsened in prison.

Dover attorney Stephen Hampton, who represented Pierce, has since filed additional lawsuits on behalf of inmates receiving negligent medical care and said little has changed regarding the state's approach to prisoner health care.

"If Pierce didn't change things, nothing will," Hampton said.

Following the newspaper's investigation, the U.S. Department of Justice's civil rights division announced in late 2006 that its investigators found "substantial civil rights violations" inside Delaware's prisons.

Federal officials announced they had reached a settlement with the DOC, despite protests from state officials and even a letter from then-Gov. Ruth Ann Minner to then-U.S. Attorney General Alberto Gonzales attempting to derail the nine-month federal probe.

Federal prison regulators identified a host of problems, including inadequate screening and health assessments, inadequate treatment of inmates with infectious diseases, inadequate treatment of inmates with serious mental illness and deficiencies in the state's suicide-prevention measures.

They found substantial civil rights violations at Baylor Women's Correctional Institution, Young Correctional Institution, Vaughn Correctional Center and the Sussex Correctional Institution.

The state signed an 87-point agreement promising to correct the deficiencies and "meet generally accepted professional standards."

After six years of working to improve inmate health, the DOC was released from the imposed agreement on the final day of 2012.

'I want the policy changed'

Another issue uncovered during the newspaper’s 2005 investigation was that no one with medical training oversaw the actions of the medical vendor, and the vendor – who got to keep any money not spent on inmate health care – controlled the grievance process.

Inmates and their loved ones complained that prisoners would not receive treatment because of that.

The DOC changed the procedure in late 2005, saying a new medical care grievance process would be put in place requiring a review of all grievances by the state and an outside monitor and that inmates would be able to seek mental health referrals in confidence.

But more than a dozen years later, family and friends of those incarcerated say that grievances are often ignored.

Connections became the vendor responsible for all prison health care in March 2014, expanding its offering from mental health and substance abuse treatment.

The state Department of Correction's contract with Connections runs more than $40 million per year.

The breach of contract lawsuit filed by Sipple's lawyer asserts that Connections is violating the rights of inmates on numerous levels, including medical care guidelines laid out by the state, the National Commission on Corrective Healthcare, the American Correctional Association and the Bureau of Correctional Healthcare Services.

"In the contract, their (prisoners) total care is entrusted with Connections," Hudson said. "They can't seek outside doctors."

Current inmates and their families share similar concerns.

The state Department of Correction and Connections were named in at least 10 lawsuits filed in the last six months related to prison medical care. Unprocessed grievances provided to The News Journal appears to show a runaround that leave inmates without healthcare.

Gerald T. Balut Jr., 37 -- a convicted robber serving more than 20 years in prison -- filed a grievance asking for mental health, but was turned down because he didn’t have the proper paperwork.

In the documents provided to the newspaper by his family, Balut scribbled that he was not provided a medical grievance.

He filed a second grievance – again not on a medical grievance form – on Jan. 5 saying he’d submitted a previous request for mental health treatment:

“This was over a year ago and I said I needed to see them ASAP. I’m still having problems and no one has come to see me,” said the form filled out by Balut, who has bipolar disorder. “I would like to speak with the warden and mental health director. I also am asking for the treatment I’m entitled to.

“I want the policy changed because they are careless and dangerous.”

That grievance was returned unprocessed. The reason provided by the DOC was:

“This is the wrong form. You cannot create your own medical grievance form. Please fill out the correct medical grievance form #585 and resubmit it.”

Dr. Emil Mikhail, a friend and power of attorney for convicted killer Monir George, said he has tried to learn more about why his friend’s grievance has not been processed.

He said he is usually turned down when he asks the DOC for information on George, who was found guilty but mentally ill of gunning down a man in 2008 during a family-oriented fundraiser for Delaware's only Egyptian Christian church.

In a series of medical grievance forms filed on Jan. 5 and provided to the newspaper by Mikhail, George claims he had placed several sick calls but has not received any “treatment and relief for my pain in different parts of my body.”

Mikhail said he heard that George had suffered a heart attack on Jan. 31. Mikhail said DOC officials turned him down, sometimes mocking him, when he tried to get information on George.

Mikhail said George called him on Tuesday and confirmed he'd suffered a heart attack and that he was treated at Kent General. He also told Mikhail that he was returned to James T. Vaughn Correctional Center 11 days prior.

DOC officials declined to comment on whether the inmate suffered a medical condition saying the Health Insurance Portability and Accountability Act of 1996, or HIPAA, bars them from disclosing medical information.

In January, the DOC said it planned to hire an independent agency to make recommendations for improving the inmate grievance process.

The independent agency selected will conduct extensive observations of the grievance procedure at Vaughn, attend grievance hearings, review past grievance complaints and meet with inmates, the state said.

The provider will be expected to issue a thorough preliminary report at the end of six months that includes findings and recommend improvements.

'It all could have been avoided'

Sipple's symptoms began as blood in his stool.

New to prison and initially housed in solitary confinement, Sipple admits he didn't quite know how to seek help. Like most people, he hoped the bleeding was merely his body adjusting to prison food and newfound stress.

But his condition didn't go away.

A few months later, in November 2015, Sipple placed his first of many written "sick call" requests to be seen by a doctor for his symptoms. It wasn't until Feb. 25, 2016, according to court documents, that he was seen by a nurse, whom he told about his "rectal discomfort and bleeding, gas, and about five bowel movements per day."

The nurse didn't examine him, according to court documents. Instead, Sipple was given a stool softener and returned to his cell, which was now in minimum security, he said.

He was seen again on March 3, 2016, for some blood work, but again, no exam or other medical testing was done despite complaining to medical staff about the same issues, the lawsuit says.

On March 26, a nurse noted that Sipple said he had a "lump" in his rectal area with symptoms dating back to November, according to court documents. The nurse said he would be scheduled to meet with a provider shortly.

This never happened, according to the suit. But nurses saw him again on July 13 and Aug. 9, 2016, noting in both cases that Sipple still complained of symptoms. In medical records, nurses described the lump as hemorrhoids but never examined him.

It wasn't until Oct. 5, 2016, that Sipple got an appointment with a nurse practitioner, court papers say.

"Without examining (Sipple), Miller advised him that his rectal bleeding, irregular bowel movements, and pain were caused by hemorrhoids," court papers say, noting that he was prescribed Preparation H medication – a cream meant to reduce imflammation of blood vessels – for the hemorrhoid diagnosis.

By now, Sipple had lost 77 pounds since his admission. The nurse described him as "thin and frail," according to court documents.

On Oct. 12, 2016, Sipple had lab work done. On Oct. 19, a Connections employee wrote that Sipple was to see a "G.I." or gastroenterologist in late February. On Dec. 12, he was told by Connections that his lab test was "not within normal limits," court filings say, but more details on the lab work weren't provided.

More blood was taken on Dec. 21. A Connections employee noted in his medical records on Jan. 12, 2017, that an appointment had been scheduled. And again on Jan. 30, a nurse described Sipple's condition:

"Patient was seen in sick call and states, 'This hemorrhoid problem is getting out of hand. There is a growth or a tumor in there and I have to wash my boxers every night.' Reports discomfort, 7 out of 10. Family history of cancer/Leukemia. Patient states, 'I'm afraid it may be cancer.'"

Sipple's cell mate at the time was relaying his symptoms to a relative who worked as a nurse at Johns Hopkins, Sipple said. The woman told Sipple's cell mate it sounded like cancer – and Sipple's concerns for his health worsened.

"Here's somebody on the outside who's not even looking at me," he said, "who's listening to the symptoms and can tell pretty much what's wrong."

On. Feb. 9, 2017, Sipple received his first rectal exam from a Connections employee, who told him he now had multiple hemorroids and did have blood in his stool, according to court records. Sipple said he remembers the medical practitioner calling over a fellow employee to look at his condition, but nothing further was done.

On Feb. 22, 2017, Sipple got an appointment with a doctor at Beebe Gastroenterology in Lewes. The doctor recommended a colonoscopy, according to court records. Sipple said the doctor never examined him.

The colonoscopy was never scheduled, according to the suit. A note from a Connections employee in Sipple's medical records dated March 22, 2017, said staff was "currently working on scheduling patient," according to court documents.

Sipple was released less than a month later on April 18. The following day, he was told he had only four to six months to live.

With the help of chemotherapy, Sipple has outlived his prognosis but the last round of drugs stopped working. He's now trying a new form of chemo with hopes it will plateau the cancer that has now spread throughout most of his body.

"It's more emotional on me because every time there's a holiday or Father's Day or anything like that, I kinda see it as this could be my last," he said. "That and the fact that more than likely, I won't be around for my daughter's wedding. This all could have been avoided."

Contact Brittany Horn at (302) 324-2771 or bhorn@delawareonline.com. Follow her on Twitter at @brittanyhorn. Contact Esteban Parra at (302) 324-2299, eparra@delawareonline.com or Twitter @eparra3.

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