An evaluation by the Department of Justice Office of the Inspector General (DOJ OIG) of the Federal Bureau of Prisons’ (BOP) colorectal cancer screening practices for inmates and their clinical follow-up for positive screenings found several serious operational and managerial deficiencies prohibiting proper colorectal cancer screening and treatment for inmates.
Fewer than two-thirds of inmates between the ages of 45 and 74 at an average risk for colorectal cancer were offered annual screenings, and fewer than half of these inmates had a current annual screening as of April 2024.
Following the results of the evaluation, the OIG made 13 recommendations to the BOP to improve adherence with screening guidelines, all of which have been agreed upon by the BOP.
Background for Evaluation
The BOP is responsible for the safekeeping and care of federal offenders, including the medical care of more than 140,000 federal inmates and pretrial detainees. Within this scope is the delivery of medically necessary health care and preventive screening services for infectious diseases, chronic diseases, cognitive impairment, and routine cancer screenings.
The DOJ OIG acknowledged that the evaluation was conducted after a series of unannounced inspections of BOP institutions and the deaths of two high-profile inmates from colorectal cancer: former FBI agent Robert Hanssen and Frederick Bardell. Both failed to receive proper cancer screenings and care for their disease. The OIG initiated an investigation into the circumstances around Mr. Bardell’s death as well.
“Documented follow-up care is crucial, as illustrated in the case of former FBI agent Robert Hanssen,” Michael Horowitz, the Inspector General for the U.S. Department of Justice, stated. “Hanssen, one of the BOP’s highest profile inmates who was convicted of espionage and sentenced to life in prison, died of metastatic colon cancer in June 2023. While in prison, he received multiple positive colorectal cancer screening results, but no colonoscopy or other documented follow-up care. As a result, the BOP first learned that he had died of metastatic colon cancer following his autopsy, and we were unable to determine why he hadn’t received a colonoscopy.”
“Bardell died of metastatic colon cancer days after being released from BOP custody on a compassionate release order. While in custody, Bardell had reported seeing blood in his stool but experienced significant delays in follow-up care. Multiple appointments occurred weeks to months later than the BOP’s target dates for them. Pursuant to a federal judge’s referral, the OIG is conducting a separate investigation into the BOP’s handling of Bardell’s case,” Mr. Horowitz said.
Evaluation Findings
The report found that the rates of offered screenings varied widely by facility, including some facilities that offered screenings to less than 10% of average-risk inmates. From a sample size of 327 inmates, about 10% had not received any documented follow-up care after getting a positive colorectal cancer screening result. About 4% of inmates did receive some follow-up care, but the records were not sufficient enough to detail what follow-up care was received.
Inmates who did have a positive colorectal cancer screening had to wait an average of 8 months from screening until they could get a colonoscopy; 6% of inmates waited more than 18 months.
Additionally, the evaluation found that the BOP’s electronic medical records system was unable to identify inmates at greater risk for developing colorectal cancer and did not have a standardized method for documenting the need for future screenings for higher-risk inmates.
Disclosure: For full disclosures, visit oig.justice.gov.
