The cracked, bleeding lesion on Michael Boswell's back started out the size of the end of a Q-tip, his sister recalls, but rapidly grew to the size of a half dollar, and then a silver dollar coin.
Incarcerated at the Washington State Penitentiary in Walla Walla, Boswell filed grievances and pleaded for treatment back in May 2019, but was rebuffed for months by prison medical staff, who said the growth was benign.
When he finally got the lesion surgically removed in September 2019, a test showed it was a malignant melanoma. A surgeon recommended "urgent" action, including scans and another surgery, which the Department of Corrections delayed for several months.
By the time Boswell had his first chemotherapy session in June 2020, the aggressive skin cancer had spread too far. He died a month later at age 37.
"He told them we have family history of cancer. They ignored it," said Boswell's sister, Meagan Kineman, by phone from Georgia. "They literally turned a blind eye."
Boswell's story is detailed in a critical new investigative report by the Office of the Corrections Ombuds (OCO), which examined 11 cases of delayed cancer diagnosis and treatment for state prison inmates over the past few years.
In addition to Boswell's death, several of the other men whose cases are recounted in the report have been told their cancers are now certainly or likely terminal, with at least two released to die at outside hospitals or other settings.
The men range in age from 35 to 68. They complained of symptoms including bloody urine and feces, recurring abdominal pain and shortness of breath, but were brushed off or not taken seriously enough, the OCO report indicates.
It took an average of 6.5 months for DOC medical staff or outside providers to diagnose the men's cancers after initial symptoms — far longer than the one-month target identified by the World Health Organization and other experts, according to the report. One man was not diagnosed for 17 months.
Such delays have been a recurring problem called out in previous OCO reports, which recounted failures leading to the cancer deaths of two inmates at Monroe Correctional Complex. The new report goes broader, examining cancer-care delays at prisons across the state.
"We obviously are concerned about what we are finding," said Joanna Carns, the OCO's director. "We keep doing these reports because the problem doesn't go away."
In a written response to the report, the DOC acknowledged the cases highlighted by the ombud's investigation "do not meet our goals" for health care.
"It is not acceptable for those under our care to experience waits for diagnostics and treatments that could potentially impact their well being," the DOC response said.
A DOC spokesperson, Jacque Coe, said in an emailed statement Friday, that the agency has taken "numerous actions to improve the efficiency, accuracy and timeliness of diagnosis and treatment of cancer patients in our Department's care."
DOC also has asked the Legislature for more money to fund needed staffing increases as well as an electronic health records system, Coe said.
"The Department takes very seriously its responsibility to deliver quality health care to individuals in its custody, and will continue to seek ways to improve the reliability and quality of patient health care," Coe added.
The DOC has seen a shake-up in its top leadership ranks in recent months, including Secretary Stephen Sinclair, who announced his retirement Jan. 26 after more than three decades with the agency.
A draft of the OCO report was delivered to Gov. Jay Inslee's office on Jan. 14, according to Carns. The report was written by Dr. Patricia David, the DOC's former director of medical quality, who left to work for OCO, the prison watchdog agency that reports to the governor.
For Boswell's family, any improvements to cancer care at DOC will come too late.
Kineman has relentlessly probed her brother's death, poring over medical records and cooperating with the OCO investigation. (The new OCO report does not identify any of the 11 inmates whose treatment it examined by name due to medical privacy laws, but Kineman confirmed her brother was the "Patient A" described in the report.)
While some DOC medical staff appeared to have genuinely tried to help Boswell, Kineman said, "there were a select few that killed him," pointing to one DOC medical staffer she said downplayed her brother's symptoms for months.
By the time Boswell died, his cancer had spread throughout his body. His eyes bulged, his skin was yellow, and black spots covered him from head to toe, said Kineman, who visited her brother days before his death.
"He progressed so fast. It's ungodly," Kineman said. "Honest to God. If he would have had the treatment, he would have been with us today."
Kineman and Boswell's mother, Rhonda Clemens, have testified before the Legislature this year, asking for reforms to prevent other inmates and families from going through what they've endured.
They've backed a proposal, Senate Bill 5119, which would require expert reviews of "unexpected fatalities" at state prisons and county jails, with reports to be posted publicly. The bill has passed the state Senate and is advancing in the House.
Boswell had been serving a sentence of more than 30 years for the 2011 attempted murder of his ex-girlfriend, whom he shot and poisoned in what he maintained was an attempt to kill himself gone awry, according to a report in The Columbian newspaper.
Despite his crime, Kineman said, her brother and other imprisoned people don't deserve to suffer because of incompetence or indifference. "Yes, they are in prison and yes, they have made mistakes but they deserve treatment," she said.
The state has a legal obligation to provide adequate medical care to prisoners under the Eighth Amendment to the U.S. Constitution, which forbids "cruel and unusual" punishment.
Kineman said her brother worked making wooden furniture while in prison, growing extremely skilled at the craft and developing respect among some guards and other DOC staff, some of whom sobbed when he died.
Kineman said she and the rest of her family have not taken legal action against the DOC because they are focused on reforms to help other prisoners and their families.
"We are not doing this for the money, we are doing this for the change," she said.