For nearly 11 months, Francisco Castaneda asked officials at the immigration detention center where he was being held to treat a lesion he worried might be cancerous.
Though several doctors repeatedly said Castaneda urgently needed a biopsy, government officials allegedly refused to authorize one, calling it an "elective" procedure, according to court records — treatment that a federal judge in Los Angeles has said appears to be "beyond cruel and unusual."
Castaneda died last month, after penile cancer spread to his lymph nodes. While in immigration custody, instead of a biopsy, he was allegedly treated with ibuprofen, antihistamines and extra boxer shorts when his lesion began to bleed on his clothes, according to government records cited in a recent court decision that allowed Castaneda's family to sue the government.
"Everyone knows that cancer is often deadly. Everyone knows that early diagnosis and treatment often saves lives," Judge Dean Pregerson wrote. "Defendants' own records bespeak of conduct that transcends negligence by miles. It bespeaks of conduct that, if true, should be taught to every law student as conduct for which the moniker 'cruel' is inadequate."
Treatment Routinely Denied, Delayed
A spokeswoman for Immigration and Customs Enforcement said she could not comment on ongoing litigation, but noted that the agency spent nearly $100 million last fiscal year on medical, dental and psychiatric care for detainees.
The number of immigrants detained has more than tripled, from about 95,000 in 2001 to more nearly 300,000 last year — and providing them with health care has been a recurring challenge for the government. At least 64 immigrants died in ICE custody between 2004 and 2007, Gary Mead, ICE's assistant director for detention and removal, told Congress last year.
A separate lawsuit filed last year by the ACLU on behalf of other detainees at the San Diego detention center where Castaneda was held claimed that medical treatment was routinely delayed or denied in order to reduce the cost of care. The immigrants in that case said they were denied medications for months and that chronic illnesses such as diabetes were inadequately monitored. In one example, a detainee said he was denied treatment for a cut to his foot until it developed gangrene and doctors recommended amputation.
Government reports have found that more than half the requests for emergency medical care from detainees in the San Diego facility took more than three days.
"It's clear that the care that they were providing is woefully inadequate on a systemic basis," said Conal Doyle, the attorney representing Castaneda's family. "This is a remarkable example of bureaucracy that is completely broken and people who are making decisions that are heartless."
Castaneda served several months in prison on a drug charge before he was transfered to immigration custody because he was in the country illegally.
Judge Pregerson wrote that the medical records cited by Castaneda's lawyers suggest that immigration officials purposefully mischarracterized his condition to avoid treating him. If Castaneda's evidence proves true, Pregerson wrote, his care "can be characterized by one word: nothing."
Castaneda first told detention center staff that he had a painful lesion on his penis in March 2006, saying that he'd had it for three years but it had recently gotten much worse, according to medical records. The next day, a physician's assistant said Castaneda should see a specialist as soon as possible to get a biopsy, according to medical records.
Unlike criminal inmates, immigration detainees need approval from officials in Washington, D.C., to get specialized care, such as a biopsy, said Tom Jawetz, an immigration detention attorney with the ACLU.
Over the next 10 months, as Castaneda's condition worsened, doctors repeatedly said he needed a biopsy to rule out the possibility that he had cancer. In June 2006, Dr. John Wilkinson, an oncologist, wrote that he "strongly" agreed that Castaneda needed an "urgent urological assessment of biopsy." He offered to admit Castaneda to the hospital that day. He wrote that he had spoken to doctors at the detention center, who "understand the need for urgent diagnosis and treatment."
The same day, according to Pregerson's decision, the Department of Immigration Health Services told Wilkinson that it would not admit Castaneda to the hospital because a biopsy is an elective outpatient procedure.
When Castaneda filed a grievance, according to his complaint, he was told that since he had not yet had a biopsy, the government decided that he did not have cancer "at this time." A DIHS report said that "this is something that can be managed also upon [Castaneda's] release as well if that is the concern here."
Castaneda was taken to the emergency room in July 2006, but did not receive a biopsy and a doctor said he probably did not have cancer.
He was given ibuprofen to treat the pain. When he complained that he was bleeding, immigration officials gave him new boxer shorts. "I tried to get medical help every day," Castaneda testified in an Oct. 2007 congressional hearing.
After the ACLU began writing letters on his behalf, he was scheduled for biopsy. According to Castaneda, a few days before his procedure, he was released from custody. He said he was told that he was released because of his medical condition. He went to the emergency room and was diagnosed with cancer that had already spread to his lymph nodes.
"It was very painful watching him get worse and worse," Castaneda's sister Yanira told ABC News. "Especially at night, when I came up to my room. I could hear him crying. I knew I couldn't do anything for him. I wanted to close my eyes and ears."
Castaneda's penis was amputated on Valentine's Day of 2007. He died earlier this year.
"What happened to him is just inexcusable," said Congresswoman Zoe Lofgren, D-Calif. "That's not level of civilized behavior that I expect from my government."
Lofgren said that the recommendations of on-site doctors should not be overruled by "some bureaucrat in a remote location."
"That's a recipe for poor medical care," she said.
Yanira Castaneda scattered her brother's ashes on Sunday.