Mississippi Prison Officials Withheld Cancer Diagnosis

Susie Balfour first started noticing painful lumps in her breast almost 30 years ago. But imprisoned in Mississippi, Balfour didn’t have access to much preventative or diagnostic health care.

In 2021, days before she was released, a prison health care official confirmed what she had long feared: She had breast cancer. Once free, Balfour immediately underwent a bilateral mammogram and extensive testing to see what treatment options were available. She learned that the cancer had progressed to stage 4, spreading to both breasts, her lymph nodes and her thoracic spine. It was untreatable and terminal.

On Wednesday, she filed a civil lawsuit in federal court against several groups and individuals that have contracted with the Mississippi Department of Corrections (MDOC) to provide health care services to prisoners, including Wexford Health Sources, Centurion of Mississippi and VitalCore Health Strategies. She accused the defendants of maintaining profit-seeking policies that discouraged adequate care, deliberate indifference to her medical needs, and medical malpractice.

These practices violate Eighth Amendment protections against cruel and unusual punishment, the complaint alleged, noting that Balfour “suffered physical and mental injuries,” including “months of unnecessary and prolonged pain and suffering, a more serious diagnosis, and a diminished life expectancy.”

“These contracts set up a financial reward to delay or flat out deny healthcare to incarcerated individuals,” Andrew Tominello, Balfour’s attorney, said in a statement. “They withheld critical care from Ms. Balfour for a decade, and that suggests they were hoping she would die in prison so they wouldn’t have to pay for the treatments she needed. What they did to this woman to increase profits is beyond callous, it’s pure evil, and we will hold them accountable.”

Balfour, who is now 62, believes that her cancer was caused by exposure to raw chemicals that she and other incarcerated women were required to use several times a day to clean the prison.

“My cancer is now untreatable because of what they did to me, and I’m standing up to prevent this from happening to others inside ― many of whom are my friends,” Balfour said in a statement. “Even when we are locked up and stripped of our rights, we should still have the right to know what is happening inside our bodies.”

Wexford, Centurion and VitalCore did not immediately respond to requests for comment. MDOC said it does not comment on active litigation.

Susie Balfour spent years seeking medical care while in prison. When she was released, she had stage 4, inoperable cancer.
Susie Balfour spent years seeking medical care while in prison. When she was released, she had stage 4, inoperable cancer.

Courtesy of Susie Balfour

In 1996, Balfour underwent a biopsy for a painful knot in her breast, she told HuffPost in an interview. The result came back benign, but Balfour still pressed for follow-up assessments. When she requested a mammogram, she was repeatedly told she could not receive one until she was 50 years old, she said. (The American Cancer Society recommends that women should start having the option to do annual mammograms at 40 years old.)

Balfour finally got a mammogram in 2011. The doctor who interpreted the test found “scattered benign appearing punctuate microcalcifications in both breasts,” but no indications of malignancy, according to the complaint. The doctor recommended Balfour return in one year for a follow-up screening.

It took 19 months before Balfour had access to another mammogram. This time, the doctor found “benign-appearing calcifications” but recommended further diagnostic testing and annual mammograms. Balfour received no further treatment or evaluation for three years, she alleged in the complaint.

Balfour had two mammograms in January and February of 2016, which showed that the calcifications had increased since her 2013 test. The doctor recommended Balfour undergo mammograms every six months. Still, she went years without care.

During Balfour’s next mammogram in 2018, the doctor again described the calcifications as benign. He did not “identify any concerning mass, architectural distortion, or suspicious calcification,” the complaint stated. However, the medical facility used a billing code that is used for procedures involving a “malignant neoplasm in the breast,” the complaint alleged. The same billing code was used at her subsequent mammograms in November 2019 and March 2021, despite no one indicating to Balfour that the lumps were cancerous.

Balfour repeatedly reported pain, tenderness and lumps in her breasts, and reminded prison staffers that she was supposed to get mammograms twice a year. When her requests went ignored, her family members called to advocate on her behalf, which sometimes resulted in retaliation from prison staff, she said in an interview.

On Nov. 3, 2021, Balfour had another mammogram. Initially, the doctor noted an “interval increase in number of multiple irregular calcifications” with “asymmetric density.” Because of the increased calcifications, the doctor recommended a biopsy to “exclude malignancy.” The pathologist who analyzed the biopsy found “an invasive mammary carcinoma” on her right breast. After receiving the results of the biopsy, the doctor who analyzed the Nov. 3 mammogram wrote an addendum to his interpretation of the test, noting an “invasive mammary carcinoma” which was “malignant and concordant,” the complaint alleged.

It took weeks for anyone to notify Balfour about her cancer diagnosis. About two weeks after the mammogram, she was called into the medical office at the Washington County Regional Correctional Facility, a prison she had recently been transferred to. There, she was told that the doctor had seen “something” on her biopsy, but refused Balfour’s requests for more information.

Instead, Balfour was transferred back to the Central Mississippi Correctional Facility, where she had previously been incarcerated, she said. It was days before Thanksgiving, and Balfour was anxious that the holiday would result in even further delays. It took calls from her family to get her into the medical office at that prison, only to be told she needed to go off grounds to speak to the doctor, she said. More time passed. Her family kept calling.

In December, Balfour finally saw a doctor who confirmed she had breast cancer. She asked what stage the cancer was in, but he said the stage wasn’t important, Balfour said in an interview.

When she pressed, he said, “It’s probably about 2,” Balfour said. “He really didn’t care.”

By then, Balfour was days from being released from prison ― after more than 33 years of incarceration.

“Even when we are locked up and stripped of our rights, we should still have the right to know what is happening inside our bodies.”

– Susie Balfour

One of the first things she did when she got out was go to the doctor for a proper screening. That’s when she learned her cancer was, in fact, stage 4 and terminal. That doctor reviewed Balfour’s previous mammograms “and found that the carcinomas in Ms. Balfour’s right and left breast were also present on those prior mammograms,” the complaint alleged, although it did not specify which previous mammogram the doctor reviewed.

The complaint identified three third-party entities that were contracted by MDOC to provide health care to people in state custody during Balfour’s incarceration: Wexford Health Sources, Centurion of Mississippi and VitalCore Health Strategies.

Wexford contracted with MDOC from 2006 until 2016. After former corrections department Commissioner Christopher Epps pleaded guilty to crimes related to a bribery scandal, MDOC switched to Centurion. In 2020, Centurion terminated its lucrative contract with the corrections department amid lawsuits from prisoners alleging poor medical care. MDOC turned to VitalCore next.

Each group was financially incentivized to “reduce outpatient referrals and diagnostic testing,” the complaint alleged.

“To further that goal, Wexford implemented lengthy and onerous procedures for approving referrals to higher levels of care which required several stages of internal review before the referral could even be approved,” the complaint said.

“Wexford’s treatment policies similarly encourage conservative care to cut costs, which causes their employees to withhold necessary medical care from incarcerated individuals with serious medical conditions which require further or frequent diagnostic testing, outside care, and/or costly medications.”

Both Centurion and VitalCore were paid a “per diem per inmate rate” by the Department of Corrections — but the prison system could recoup a deduction if it paid for medical care that Centurion or VitalCore did not provide, according to the complaint. “The terms similarly encouraged conservative care and cost cutting measures resulting in the deprivation of necessary medical care from incarcerated individuals,” the complaint alleged.

Pauline Rogers, the executive director of the Wendy Hatcher Transitional Home for Women, and a friend of Balfour’s, said in an interview she often sees people leave Mississippi prisons with severe untreated health problems, including cancer, diabetes and infections.

“It’s a chore just to get a Band-Aid in prison,” she said.

A major part of Rogers’ reentry work is helping formerly incarcerated people — who often do not have health insurance or even identification — access health care.

Last September, Balfour gave Rogers an early birthday present. Rogers’ birthday wasn’t until December, but Balfour wasn’t sure she’d be alive by then.

“I can’t tell you why I’m still here,” Balfour said. “But I believe that I’m here for a reason. Because of the other ladies. I’m just trying to stay strong for them.”

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