Another month passed without his condition changing, while immigration officials continued, with Kafkaesque efficiency, to document his pain: “The lesion on his penis is draining clear, foul malodorous smell.” The “foreskin is bleeding at this time and the patient states his colon feels swollen.”
A new request for treatment authorization states that “the lesion now appears to be ‘exploding’ for lack of better words.” This request was approved, and in mid-July Castaneda was taken to the emergency room at Scripps Mercy hospital in Chula Vista.
At Scripps, emergency room doctor Juan Tovar documented the “fungating lesion” and made arrangements for Castaneda to be admitted to the hospital, where Tovar, like Walker, wanted to “rule out cancer, versus [an] infectious etiology.”
Next, Scripps urologist Dr. Daniel Hunting performed a brief exam but did not biopsy the lesion. Instead, Hunting “guessed that the problem was condyloma,” or genital warts. Documents reveal that Dr. Hunting did not ask about a family history of cancer and referred the patient back to his primary urologist, dismissing the symptoms as “not an urgent problem.” Castaneda was handcuffed and shackled and returned to Otay Mesa.
He Begged for Amoxicillin, but His Request Was Denied
In July, facing not only the complications of his medical condition but a complicated detainee health-care bureaucracy, Castaneda again saw Walker. Walker requested an early release to allow Castaneda to seek medical care on his own, but Castaneda was not released. A week later, David Lusche, a physician’s assistant at the Otay Mesa facility, wrote that he explained to Castaneda the following: “While a surgical procedure might be recommended long-term that does not imply that the Federal Government is obligated to provide that surgery if the condition is not threatening to life, limb or eyesight.” Castaneda filed a grievance against Lusche, but that was denied. Officials still considered his surgery “elective” and therefore disallowable. Castaneda was characterized in this report as “conversational and calm, not confrontational.”
In August 2006, Castaneda was sent to see Dr. Masters, another outside urologist whose opinion he hoped would bolster that of Dr. Wilkinson. Dr. Masters recommended a biopsy and circumcision and said that he would arrange admission to a hospital, but again Castaneda did not receive treatment.
By fall, the pain was so bad that Castaneda couldn’t sleep at night. He was given antihistamines and trazodone, a strong sedative with antidepressant properties. The ibuprofen he took for pain, he said, had “no effect.” He told registered nurse Joanne Galano that at night he’d have a “white discharge” and the lesion was “getting bigger.” She noted “a whitish growth approximately 8 mm in diameter.” The nurse noted that 800 mg of ibuprofen was having no effect on his pain. He begged for amoxicillin, but his request was denied.
In October 2006, six months after his first medical evaluation at Otay Mesa, a prison guard noted that he “saw some dried blood on [Castaneda’s] boxers.” In early November, Castaneda told health officials that there was a “constant pinching pain, especially at night.” He said his rectum had swollen, which made his “bowel movements hard.”
If this weren’t enough, a second lesion appeared, on the underside of his penis. This lesion was moist, and Castaneda could not stand and urinate because the urine sprayed everywhere and he could not direct the stream. The treatment ordered: seven pairs of boxer shorts brought in weekly.
Also that fall, a Division of Immigration Health Services memo seems to acknowledge that officials knew Castaneda needed treatment and recognized it would be impossible for him to seek it himself. The memo states that Castaneda cannot “be released to seek further care due to mandatory hold and, according to Immigration and Customs Enforcement authorities, may be with this facility for quite a while.”
Equally damning is the charge that authorities may have tried to cover up their inadequate treatment by altering official government records. In July, physician’s assistant Lusche emailed a colleague that Castaneda’s grievance needed to be altered because federal auditors were coming to inspect Otay Mesa’s medical files. “We need to write something different,” Lusche wrote, “or make some amendment on the grievance for Francisco Castaneda.” The grievance stated that his case was “not resolved,” which would “attract all kinds of attention.” “Could you,” Lusche asked his colleague, “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.”
Mid-November, Castaneda was transferred to the San Pedro Service Processing Center, in Los Angeles. On his summary form, an immigration official said Castaneda had no “current medical problems.” According to an article in the Progressive magazine, Castaneda had been “forced to leave behind all his possessions, including his legal and medical papers.” Roused by a fellow inmate, he contacted the American Civil Liberties Union and explained his eight-month fight with immigration’s health officials. Attorney Tom Jawetz of the ACLU’s National Prison Project began writing letters in December on behalf of Castaneda. (One reason the ACLU and other prisoner-rights advocates take on such cases is that detainees, unlike criminal defendants, have no right to free counsel.) Jawetz wrote to ICE and Health Services Administration officials that Castaneda’s “long term health is being jeopardized by the lack of appropriate medical care he continues to receive in ICE custody.”
Jawetz’s letters had impact. On Thursday, December 14, Castaneda was taken off-site to see San Pedro urologist Lawrence Greenberg, who wrote that his penis was a “mess.” He required a circumcision. Greenberg’s exam noted that Castaneda was in “severe pain.”
That weekend, a lump appeared in Castaneda’s groin, and he filled out another sick-call slip. Castaneda’s surgical consult was forwarded to Asghar Askari, another urologist. It was not until 40 days later that Askari examined the fungating penile lesion on Castaneda and the lump in his groin; his assessment was “most likely penile cancer.” Askari ordered a biopsy, which was scheduled for early February 2007, almost a year after ICE officials had diagnosed Castaneda with a lesion on his penis.